TOWN OF OAKHAM
OFFICE OF THE TOWN CLERK
Business Certificate
In Conformity with the provisions of Chapter One Hundred and Ten, Section Five of the General Laws, as amended, the undersigned herby declare(s) that a Business is conducted under the title of:
At the location of:_________________________________________________________
Street address Mailing address
By the following named person(s): Include corporate name and title, if corporate officer. Please type or print. Name/Title Street/Mail Address
________________________________ _____________________________
________________________________ _____________________________
________________________________ _____________________________
________________________________ _____________________________
SIGNATURES:
________________________________ ______________________________
________________________________ ______________________________
ON_______________the above named person(s) personally appeared before me and make oath that the foregoing statement is true.
Identification Presented: Drivers License#:__________________________Other:___________________
In accordance with the provisions of Chapter 337 of the Acts of 1983 and Chapter 110, Section 5 of MGL, Business Certificates shall be in effect for fours years from the date of issue and shall be renewed each four years thereafter. A statement under oath must be filed with the City 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 ($300.00) for each month during which such violation continues.
THIS FORM MUST BE RETURNED TO THE TOWN CLERK WITH A CHECK FOR $20.00. Checks should be made payable to the Town of Oakham.
RECEIVED______________________________ CERTIFICATEXPIRES:________________________
Christine Mardirosian/Town Clerk