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rowly <br /> tsr, qr <br /> off...° <br /> L TOWN OF MASHPEE <br /> `nnBLc iii^ <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 /> i <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 from)(withdrawn from)the business of 11b n I,pV� 8-O 0-0 <br /> conducted at l A Q 1 S 5 P f 11 U <br /> STREET <br /> u / <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 /> tt <br /> on Name of Business has been changed to <br /> . <br /> SIGNATDRE <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 /> Origform/Discontinuance <br />