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gr iy� TOWN OF KASBPEE <br /> _ • �ry�^OLC CO'� <br /> 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 /> 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 that I/We has (have) this day discontinued (retired <br /> from) (withdrawn from the business of S <br /> conducted at aa-A/ an — 0& 62a f / <br /> STREET <br /> SIGNATURE _ <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 it�,dl� I I has been changed to <br /> N e of Business -Na n 2&V'10-2 <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 /> Mn YC�n 8 . <br /> Barnstable ss. Notary r <br /> I Date <br /> Personally appeared before me the above name, ` t'"f1 GC` U� d made oath <br /> that the foregoing statements are true. Lrfla k:1 <br /> • - � ' a-Notary Public <br /> Q Deborah F.Daml <br /> NOTARY PUBLIC r t+. Commission Expires <br /> ougform/Discontinuance Commonwealth of Massachusefts <br /> My Commission Expires July,24;2069 <br />