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"VJOWN o' <br /> Nil � )F1 <br /> TOWN OF N ASBPEE <br /> 9Rry4, v.. :ct`15 <br /> a1,C C�.• <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 /> Z- %-7 �6 <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 from)(withdrawn from)the business of <br /> conducted at <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 Name of Business has been changed to <br /> • <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 /> beenchangedfrom Slfpk4hl f !� , (�tzdc J <br /> to �Fv C). 1 We <br /> SIGNATURE <br /> Notary fltCLd! l �OlJ�o <br /> Barnstable ss. <br /> Date <br /> Personally appeared before me,the above named 42* [! Yu QT +d made oath <br /> that the foregoing statements are true. <br /> • arae-Notary Public <br /> ,� Leh F. Dami <br /> NOTARY PUBLIC Commission Expires <br /> Maudmuft <br /> Origfonn/Disconnnuance �of <br /> MY C0MMfton Elle M J*24,YW9 <br />