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o 1r <br /> O�R rP 4h q'�'pv1• ,0.1'IO � ' <br /> TOWN OF MASHPEE <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 /> The Town is desirous of going"Green" as much as possible.To that end,please include your email address. <br /> Email Address: <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 herebyeclare(s) that I/We has (have) this day discontinued (retired <br /> from) (withdrawn from) the business of U y1 <br /> conducted at � L-P 4__G <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 /> A� <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 <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 /> Ori gform/Discontinuance <br />