Laserfiche WebLink
4� BUSINESS CERTIFICATf�E #&W-01% <br /> ` TIIECOAIMONWEALTHOFMASSA CHUSETTS <br /> TO PVA'OF MASFIPEE ✓ <br /> DATE z1 1— y" <br /> Expiration Date: Z ly�,L D/ <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declare(s) that a business under the title of / ,QI <br /> Ger�,tl lJ ' LL-A Lta/ n D DBA SP�kNGI�py " L 5 IYSV P is conducted at <br /> Business Location: ga <br /> Business MailingAddress: <br /> `ress16,0 / x(92 u�3 14A4 �� c/ <br /> (/ <br /> Business Type: Ate„X LS_Q.4 (�l` Busiiness Telephone: <br /> Homc Phone: <br /> by the following named persons: <br /> FULL NAME RESID NCE LA", <br /> re d J' �fwtrina ao P�t�z G"� s <br /> I certify 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 /> taxes as reqUire4i under law. <br /> gnire of auth a agent/ "Signature of authorized agent <br /> C lei-.',�(- W'7 7 <br /> "*Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alami Company: <br /> *This license Nvili not be issued unless this certification is signed by applicant <br /> ""Yomsocial security number will be furnished 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 Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Nlassachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named fY1'�d'�.� U K t n/ n and made oath that the foregoing statement is <br /> 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 <br /> each four years then after s long as ch usiness shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • ���, J AZZUCCNELLI,JR <br /> SEAL oUAt <br /> Mp Cptvtiias0n F�itei <br /> i <br />