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- <br /> O:� p <br /> w! CC M <br /> ell' <br /> TOWN OF MASHPEE <br /> yS7Alil,i;CO" <br /> Statement o1'Discontinuance,Change of Residence,Change of Location of Business, <br /> Withdrawal, or Deceased from Business or Partnership,Change of Busine Name or Owner Name <br /> DATE <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 eclare(s) that YXe s (have) t is da disco tinued (refired <br /> from) (withdrawn from) the business of <br /> conducted ate 1—�— 'q <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 or the owner as it appears on the Business Certificate has <br /> been changed from <br /> to <br /> SIGNATURE <br /> Notary January 10, 2008 <br /> Barnstable ss. <br /> QDate <br /> Personally appeared before me th��aA?a1100..�YN4o I `v��� f // and made oath <br /> ` \5o <br /> • that the foregoing statements at*teyt`e .�,....... <br /> Ci p,A � <br /> �:�+�ti mos'• v� <br /> ;AV.m _ is Flowus Lister <br /> Name-Notary Pu he <br /> 10/12/2012 <br /> i Q'•.o b':�� <br /> �'�1f°y c +�•Q�Q'` <br /> Commission Expires <br /> OrigfornVDiscontinuance ,//xxx��,J11111111Utts?`\\`\ <br />