Laserfiche WebLink
t\F �OFy <br /> Vit. �,.�•�, ,\y� <br /> - TOWN OF NLkSHPEE <br /> AN <br /> �auec 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 herebydeclares) that Me has (have) this day discontinued (retired <br /> from) (withdrawn from)the business of <br /> conducted at <br /> STREET <br /> SI&AURE <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 1-4 AIIJY'dU/L O mc- <br /> to /) 5,9 e <br /> SIGNATURE <br /> QY <br /> arga tuo <br /> o ary <br /> Barnstable ss. NOTARY PUBLIC �-a3 -OCommonwealth of Massachusetts <br /> Due <br /> My Commission Expires Sept.24,2010 <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 /> Origfomt/Discontinuance <br />