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YoWN�. o <br /> TOWN OF MASHPEE <br /> tiyyAiicii; <br /> Statement of Discontinuance,Change of Residence,Change of Location of Business, <br /> Withdrawal,or Deceased from Business or Partnership,Change of Business ameo Owner Name <br /> 6 0 <br /> DA E, <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 from) (withdrawn from)the business of 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 has been changed to <br /> Name of Business <br /> 71- <br /> / SIGNATURE <br /> /� <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 froom �/y0 //�0 yyt /j{ {may t <br /> to _ �// re /'lid 0M / Jr�z°i�� �A <br /> zEd <br /> SIGNATURE <br /> Notary D <br /> Barnstable ss. <br /> Date <br /> Personally appeared before me the above named '-�C h t� and made oath <br /> that the foregoing statements are true. <br /> —t <br /> N t Notary Public <br /> �I�xEALTH <br /> OF MA33�CNU <br /> mn' <br /> C m on <br /> _ Expires pgobe125,1p19. <br /> Origform/Discontinuance ��� <br />