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BUSINESS CERTIFICATE <br /> TOWN OF MASHPEE <br /> Date: <br /> • Expiration Date: Z 3 Jr <br /> In conformity with the provisions of Chapter 110, §5 of the Massachusetts General Laws, as amended, the <br /> undersigned hereby declare(s)that a business under the title of <br /> Business Name/DBA: Starbucks-Store 7250 Corporation Name: Starbucks Corporation <br /> j is conducted at Business Location: 6 Market Street Certificate No. 2010-134 <br /> Business Type: retail/cafe <br /> New r] Renewal Veolmmercial [] Residential [ ] Email Address: <br /> Business Mailing Address: PO Box 34442 Tax 2 Seattle, WA 98124 <br /> Business Telephone: 508-477-5806 Home [ ] Cell ( ] Phone: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> :�40L-��g <br /> 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 <br /> all st taxes as required under law. <br /> *-S na re of authorized agent **Social Security Number <br /> *Th tcense will not be issued unless this certification is signed by applicant or Federal Identification <br /> Number(Required) <br /> In case of emergency <br /> p <br /> NAME:_i (,Yl�/l�tD TELEPHONE NUMBER: <br /> Alarm Company: &944 l/ T <br /> "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax <br /> filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subiect to license suspension or <br /> revocation. This request is made under the authority of Chapter 62C,§49A Massachusetts General Laws <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE: ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing <br /> statement is true. <br /> certificate issued in acc danc with this section shall be in force and effect for fo cars from the date of issue and shall be <br /> renewer � ness shall bQapAsbE��d��shall laps and b oid e s so re ea• <br /> _ SNI A S <br /> Signer O -t�, ��Ssiory•N�P/+bli // 0 ' <br /> • = y' DEC Co9rAtnissico Expires <br /> Oil <br /> 2015 <br /> $ tip? <br />