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Y� <br /> 'TOWN 0 <br /> TOWN.OF MASHPEE <br /> q'Ys'iauEe 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 /> l 1 rol6c� <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 declare(s) that I/We has (have)this day,discontinued (retired <br /> from) (withdrawn from)the business of 0(la— 1 lc 10 <br /> conducted at �)o X12 <br /> STREET <br /> SIGNATURE <br /> p <br /> Change ofLocation ofBusin ss <br /> I hereby state that the location off the(business/my residence as it appears on the Business Certificate filed <br /> on �b 1 22a rl l.�1(1116( has been changed to <br /> • me 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 /> OrigfomdDiscontinumce <br />