Town of Carlisle massachusetts
66 westford street
carlisle, ma 01741
APPLICATION/RENEWAL FOR
BUSINESS
CERTIFICATE
All applications must meet the Carlisle Zoning Bylaws Section 3.2
FEE: $25.00 for four (4) year certificate
(978) 369-6155
(978) 371-0594
Street Address: Zoning District:
Owner or Tenant:
Second
Signature (Business Partner, if needed):
Business Name: Phone #:
Detailed Description of the Proposed Business:
Certification Clause:
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 taxes required under law.
*Signature of Individual or Corporate Name (Mandatory) By Corporate Officer (Mandatory if Applicable)
**Social Security Number or Federal ID Number
*This license will not be issued unless this certificate is signed by applicant.
**Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether
you have met tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will
be subject to License suspension or revocation. This request is made under the authority of Mass. G.L. 62C, S 49A.
$25.00 fee Check No.
Owner’s Signature: Date:
Date:
Town Clerk:
Date:
click to sign
signature
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click to sign
signature
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click to sign
signature
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