City of Boston
BUSIESS CERTIFICATE Filing Fee: $65.00
ew Filing Renewal
This Certificate Expires on: _______________________________________
U
nder the provisions of Chapter 110, Section 5 of the Massachusetts General Laws, as
amended, the undersigned hereby declares that a business under the title of:
is being conducted at:
(Please Print Clearly)
_______________________________________________________________________
(P. O. Box not permitted) (City) (State) (Zip Code)
By the following individual (s) or Corporation Corporation or Residential Address
Print Full ame (s) (P.O. Box not permitted)
___________________________________ _______________________________________________
________________________________________________ ________________________________________________________________
________________________________________________ ________________________________________________________________
Signatures:_______________________ ________________________ _________________________
Individuals MUST have their signatures notarized on the back of this form prior to filing in the Office of the City Clerk.
Local Telephone umber:
_________________________________
Type of Business:
________________________________________
Email Address:_____________________________________ Website: ________________________________
IMPORTAT OTICE
!
City of Boston Certification
original document filed on the above date
Attest:
City Clerk
MA
CHARLESTOWN
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