Town of Tisbury, MA - Town Clerk Renewal Form

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Tisbury Town Hall
51 Spring Street
P.O. Box 1239
Vineyard Haven, MA 02568

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		$20.00 FILING FEE
U NEW	TOWN OF TISBURY	DATE FILED ________________

U RENEWAL	BUSINESS CERTIFICATE	EXP DATE __________________

IN CONFORMITY WITH THE PROVISIONS OF CHAPTER 110, SECTION 5 OF THE MASSACHUSETTS GENERAL LAWS,
AS AMENDED, THE UNDERSIGNED HEREBY DECLARES THAT A BUSINESS IS CONDUCTED UNDER THE TITLE OF:

	NAME OF BUSINESS (DOING BUSINESS AS)
	# STREET
	TOWN, STATE	TISBURY, MASSACHUSETTS
BUSINESS INFORMATION	MAILING ADDRESS
	MAILIG TOWN, STATE, ZIP
	BUSINESS PHONE
	NATURE OF BUSINESS
	U RETAIL SALES	U SERVICE	U WHOLESALE

BY THE FOLLOWING NAMED PERSONS(S): (INCLUDE CORPORATE NAME AND TITLE OF CORPORATE OFFICER)

	OWNER/CORPORATE NAME
	IF CORP, TITLE OF OFFICER
OWNER INFORMATION	RESIDENCE/CORPORATE ADDRESS
	RESIDENCE/CORPORATE MAILING ADDRESS
	RESIDENCE/CORPORATE PHONE

Signed under the penalties of perjury:

_______________________________
Owner(s)/corporate officer signature

IN ACCORDANCE WITH THE PROVISIONS OF CHAPTER 110, SECTION 5 OF THE MASS. GENERAL LAWS, BUSINESS CERTIFICATES SHALL BE IN EFFECT FOR FOUR YEARS FROM THE DATE OF ISSUE AND SHALL BE RENEWED EVERY FOUR YEARS THEREAFTER. A STATEMENT UNDER OATH MUST BE FILED WITH THE TOWN CLERK UPON DISCONTINUING, RETIRING, OR WITHDRAWING FROM SUCH BUSINESS OR PARTNERSHIP. COPIES OF SUCH CERTIFICATES SHALL BE AVAILABLE AT THE ADDRESS AT WHICH SUCH BUSINESS IS CONDUCTED AND SHALL BE FURNISHED ON REQUEST DURING REGULAR BUSINESS HOURS TO ANY PERSON WHO HAS PURCHASED GOODS OR SERVICES FROM SUCH BUSINESS. VIOLATIONS ARE SUBJECT TO A FINE OF NOT MORE THAN THREE HUNDRED DOLLARS ($300) FOR EACH MONTH DURING WHICH SUCH VIOLATION CONTINUES.

FOR OFFICE OR NOTARY USE ONLY

Date: _________________

Then personally appeared before me the above named

___________________________________________

and made oath that the foregoing is true.

__________________________________________

Town Clerk/Notary

My commission expires:
___________________________

TISBURY TOWN CLERK PO Box 606, Vineyard Haven, MA 02568-0606 Phone: 508-696-4215 Fax: 508-693-5876

November 2008

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