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2004
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2004
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Last modified
12/1/2016 8:56:20 PM
Creation date
11/13/2016 10:16:15 PM
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BoxNumber
Box 037
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1-,oU .l - <br /> TOWN OF MASHPEE <br /> .co��. Statement of Discontinuance, Change of Residence, Change of Location of Business, <br /> Withdrawal,or Deceased from Business or Partnership,Change of Business Name or Owner Name <br /> DATE <br /> The Town is desirous of going"Green" as much as possible. To that end, please include your email address. <br /> Email Address: Ac (� .Corn <br /> Discontinuance <br /> In conformity with the provisions of Chapter one hundred and ten, section five, of the General <br /> Laws, as amended, the undersigned hereby declares) th=e has (have) this day discontinued (retired <br /> from) (withdrawn from)the business of 4 i } rke M r n�trp(`SCS <br /> conducted at y3 4;c", coue, l lrdG <br /> STREET� <br /> Pep <br /> SIGNAT <br /> Change of Location of Business <br /> I hereby state that the location of the business/my residence as it appears on the Business Certificate filed <br /> on has been changed to <br /> Name of Business <br /> SIGNATURE <br /> Change of Name of Business or Owner <br /> I hereby state that the name of the business or the owner as it appears on the Business Certificate has <br /> been changed from <br /> to <br /> SIGNATURE <br /> Notary <br /> Barnstable ss. <br /> Date <br /> Personally appeared before me the above named and made oath <br /> that the foregoing statements are true. <br /> Name-Notary Public <br /> Commission Expires <br /> Orig furmlD Isconti n uan ce <br />
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