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�/o e <br /> e; TOWN OF MASI-IPLE <br /> S/AIII,L�V <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 /> Li 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 from) (withdrawn from)the business of 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 /> SIGNATURE <br /> Change of Name of Business or Owner <br /> I hereby state that the name of the business of the owner as it appears on the Business Certificate has c _ <br /> been changed fiom a bCePn (VI w" -m� `k'��-At 1' IQ ,ng lleCif'�tLt 0-kCe S <br /> to V,c\Dnj)af i ay 00 OaWs�ce 'Marine - lee+(,cat Seru ccs <br /> SIGNAT E <br /> 1 <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 /> JO <br /> otaryPublic <br /> I €yaN4fA TH OF MASSACHUSETTS <br /> mission <br /> .. Od0b&25,2D13 <br /> Orierorm/Discontinuance <br />