20.084 Norman Menard TaxesCity of Northampton
STATEMENT OF ALL TAXES FILED AND PAID
Name of Business: Norman E. Menard
Location of Business: 25 Garfield Avenue
The licenses (as a/for a) Secondhand Dealer and Junk Dealer will not be issued unless this
certification clause is signed by the applicant listed on the license.
1, [11) e-t /VV It -'�tl E-19int name of owner or authorized agent of the
business) certify under the penalties of perjury that I, to my best knowledge and belief, have
field all state tax returns and paid all state taxes as required under law.
Signature of Owner or Agent
M Milklighm- or [ll]
Social Security Number Federal Identification Number
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. Licenses 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 Massachusetts General Law, chapter 62C, section
49A,