T O W N O F W I L M I N G T O N
121 GLEN ROAD
WILMINGTON, MA 01887
THE OFFICE VOICE (978) 658-2030
OF TOWN CLERK FAX (978) 657-7564
Website: www.wilmingtonma.gov
Business Certificate – Notary Form
Number:_____________ Date:_____________
In conformity with the provisions of MGL Chapter 110, Section 5, as amended, the undersigned hereby declare (s)
that a business under the title of
_____________________________________________________________________________________________
Name of Business Telephone #
_____________________________________________________________________________________________
Type of Business
_____________________________________________________________________________________________
Address of Business
Wilmington, Massachusetts by the following named persons:
Full Name: Home Phone:
_________________________________________ ________________________________________________
Home Address: Email Address:
_________________________________________ ________________________________________________
Signed:
_________________________________________ ________________________________________________
Signature Signature
The Commonwealth of Massachusetts
__________________, ss __________________, 20_____
Personally appeared before me the above-named______________________________________________________
and made oath that the foregoing statement is true.
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 four years thereafter.
Business Certificate Expiration Date:___________ Notary
New ___ Renew ___Change of owner/partner___ _________________________________________
Expiration Date:
Entered
Issuance of a Business Certificate does not constitute legal use under Zoning.
