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?gwnuPn ✓'vod �� I <br /> 04 e4°y.�\ fury <br /> WI �a ,� TOWN OFMASHPEE <br /> ��'nriufi;;co�� Statement of Discontinuance,Change of Residence,Change of Location of Business, <br /> Withdrawal,or Deceased from Business or Partnership,Change of BI sss Name or Owner Name <br /> (311in� o <br /> ATE <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 hereby eclar�(s)/th t U U—a,S ve) t} day i�c�onue retired <br /> from) (withdrawn from) the business of �7�4//� ��{{' ) (y <br /> conducted at� <br /> .TRE T <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 or the owner as it appears on the Business Certificate has <br /> been changed from <br /> to <br /> SIGNATURE <br /> Notary 3 tn"- <br /> Barnstable s5. <br /> Date <br /> Personally appeared before me the above named �rZ dt/ and made oath <br /> that the foi&egonfg statements aPe true. <br /> i P N019o� <br /> NWLALim OF <br /> �n xprWoo,misston Expires <br /> October 25.2)13 <br /> Ori gform/Disconti nuance <br />