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tl <br /> ♦ ON'N <br /> or 4 <br /> TOWN OF MASHPEE <br /> �AUL6 G6, <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 /> 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 from)(withdrawn from)the business of GQ p{ tN L �] e S t bM ({IfTzNNMLS DES/yv �lu vS t>ZgCto v <br /> conducted at ` elyanview #VE NUE, n43IPIt'E — Ffp4 0264 9 <br /> STREET <br /> SIGNATU <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 /> • <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 /> Ongform/Di sconti nuance <br />