40 BALCOMB STREET - BUILDING JACKET 40 BALCOMB STREET
Business Certificate
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DATE FILED U ��`1 Gy 2C'e0/ Type: X New
Expiration Date- {law za 2-eo 4 ❑ Renewal, no change
Number-_ aeoo - IAF- ❑ Renewal with chance
In conformity with the ' ions
of Chapter one hundred and ten, Section five of the Massachusetts General
Laws, as amended, the undersigned hereby declare(s) that a business is conducted under the title of.
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type of business-CCry.17a r Le n J2�,OA,•11�i d-
by the following named person(s): (Include corporate name and title if corporate officer)
Full Name Residence Tel J
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on LT— the above named person(s) personally appeared before me and made an
oath that a foregoing statement is true.
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CIT Y CLERK - -----------------------------------------------------
Notary
------------------------------------ - - --------
Notary Public
(seal)
Date Commission Expires
ldentificationPresented
State Tax I.D. # S.S. 4 f`
(if available)
In accordance with the provision of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5, of Mass.
General Laws, business certificates shall be in effect for four(4) years from the date of issue and shall be
renewed each four vears thereafter. A statement under oath must be filed with the town 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 connnues.
GAB Robins North America, Inc.
220 Norwood Park South
Norwood, MA 02062
Date 1/7/99
Building Commissioner/Inspector of Buildings
Town of Salem
Salem, Ma. 01970
Board of Health/Board of Selectmen
Town of Salem
Salem, Ma. 01970
NOTICE OF CASUALTY LOSS TO BUILDING
CY1B
Rol)ilts UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B
GAB Robina North America,Inc.
Claim has been made involving loss, damage or destruction of the property captioned below,
which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section
6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B
is appropriate, please direct it to the attention of the writer and include a reference to the cap-
tioned insured, location, policy number, date of loss, and GAB Robins file number.
Insured : Roland & Paulette Gendron
Property Address : 40 Balcomb St.
Salem, Ms. 01970
Policy No. HP1118975
Loss of 12/12/98
GAB Robins File No. 10303-11925
(Signature)
Title : Adjuster
On this date, I caused copies of this notice to be sent to the persons named above at the addresses
indicated above by first class mail.
Signature and date
Form 645(2!78)
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TE FILED o 2 Type: ❑ New
Expiration Date - ❑ Renewal, no change
Number 4�-tfii Renewal with change
In conformity with the provisions of Chapter one hundred and ten, Section five of the Massachusetts General
Laws, as amended, the undersigned hereby declare(s) that a business is conducted under the title of:
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type of business — RPL4 "(Q L r
by the following named person(s): (Include corporate name and title if corporate officer)
Full Name Residence
An RFI Gco"' R S% t Si96✓ m
Si natures
-------------------- -----------------------------------------------------
---- ----------------------------------------------- -----------------------------------------------------
on l 19 re bove named person(s) personally appeared before me and made ;In
o that the foregoing statement is true.
- --- -- -
- - - - - - -
--- ----------------------------------------- Notary-Publi----c--
(seal)
Date Commission Expires
Identification Presented
State Tax I.D. # S.S. #
(if available)
In accordance with the provision of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5, of Mass.
General Laws, business certificates shall be in effect for four(4) years from the date of issue and shall be
renewed each four years thereafter. A statement under oath must be.filed with the town 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 subiect to a fine of not more than three hundred dollars ($300.00) for each month during which
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