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4 t'v.T, 'or. <br /> TOWN OF kXSHPEE <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 /> Y-D8- <br /> DATE <br /> Discoatinuance <br /> In conformity with the provisions of Chapter one hundred and ten, section five, of the General <br /> Laws, as amended, the undersigned hereby declares) that I/We has (have) this day discontinued (retired <br /> from) (withdrawn from)the business of —/)?OrQ <br /> i <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 Name of Business has been changed to <br /> • <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 ��t�fFab �' Lees c4l itbl f rk1CX7-6*&-e- <br /> to b/, ton>6 ;E� Y,se S <br /> I4 7 7- V-77 <br /> SIGNATURE <br /> Barnstable ss. Notary <br /> Date <br /> Personally appeared before me the above named �dweQ — S and made oath <br /> that the foregoing statements are true. <br /> 0 v ` <br /> Deborah F..Dam' <br /> °� NOTARY PUBLIC a-Not ublic <br /> Commonwealth-at Massachusetts <br /> My Commission Expires July 24,20 Commission Expires <br /> OrigfonNDiscontinuance - <br />