Laserfiche WebLink
BUS]NESS•CERTWICATE# c9Q is� ) <br /> THE COMMONWEAL'THOFMASSACHUSETTS <br /> TOWNOFMASHPEE 'V17 <br /> /S <br /> DATE <br /> • q�w�i 9 <br /> Expiration Date: <br /> In conformity with the provisions of Chapter 110, §5 of the Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title of <br /> Business Name/DBA: 60mb]e S6,2-0- el LX_ a1SCorporation Name: QUmbk L ( , L. <br /> is conducted at Business Location: 359 ROCA(- Lck,-A -14-[[Aeommercial V Residential_ <br /> Business Mailing Address: ate Ulla i nc1 'L l Q �Uci l( <br /> Business Type: f R Qr {t>`4 S Business Telephone: 5Z)a- - L4 77- ,51, 0 3 O <br /> New [l0] Renewal <br /> / [ ], Home Phone: . 27(t - 26S_-2 t L4 -, <br /> Email Address: U-t r-L& Skrna. l . CUvh <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> dict leery �t, UuFK cdbl junn' g Lip*- LUaj , MgS�,eoo <br /> p> <br /> Second Owner Name 'Second Owner Address <br /> tify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> red under law. <br /> � <br /> 4-7- 1 R 33 9 to(P <br /> *Signat re of authorized agent **Social Security Number or <br /> or Federal Identification Number(Required) <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> Name: Telephone Number: <br /> Alarm Company: <br /> "Your social security number will be famished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subiect to license suspension or revocation. This request <br /> is made under the authority of Chapter 62C, §49A of Massachusetts General Laws. <br /> The Commonwealth of Massachusetts BARNSTABLE ss 1' DATE y cJ IS <br /> Personally appeared before me the above-named�el+h]Ben Ot.V rK and made oath that the foregoing statement is true. <br /> A certificate issued in accordance with this section shall be in force and effect for four years from the date of issue and shall be renewed each <br /> four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Si ned �� . <br /> "`--TTTIII Notary Public <br /> -SEAL Deborah Dami <br /> o� NOTARY PUBLIC <br /> Commission Expires: <br /> Commonweaflh of Massachusetts <br /> My Commission Expires July 29,2016 <br />