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ray. <br /> TOWN OF MASHPEF <br /> ia 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 /> —/ 5- 08 <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 declare(s) that I/We has (have) this day discontinued (retired <br /> from) (withdrawn from)the business of 51"J `o 77 <br /> conducted at �/5� 7 7 �u , n �t.�ti. ssa+ At/e. rh a8ti p ee_ MA ° RC Y9 <br /> STREET <br /> NATURE <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 <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 /> Origiorm/Discontinuance <br />