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V! <br /> W <br /> TOWN OF MASHPEE <br /> Statement of Discontinuance,Change of Residence,Change of Location of Business, <br /> �'na`u�i co Irawal,or Deceased from Business or Partnership,Change of Business Name or Owner Name <br /> DATE <br /> The Town is desirous of going"Green" ass "much as possible.To that end,please include your email address. <br /> Email Address: lfa,' LOZQ 1//!r' 'P V/0,007 <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 from) (withdrawn from)the business of 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 /> 0 �cz/rh0�iIfY �ii�`faao ,R /�lr�S���hJr4 0���'� <br /> Change of Location of Business <br /> I hereby state that the location <br /> �of the business/my residence as it appears on the Business Certificate filed <br /> onL ' 'Q. -. C;:aw, 4 ZXe has been changed to . <br /> • Name of Business <br /> �'0 a s/!?-z del 1 r x1w�!_zA,! � 4 z?zd <br /> ISIGNATURE <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 5s. <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 /> Ongform/Disconti nuance <br />