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TOWN OF MASHPEE <br /> OLG Lam' <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 /> 3-aa_© <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 from) (withdrawn from)the business of <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 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 <br /> eeof the business or the owner as it appears on the Business Certificate has <br /> been changed from /V f o`5 A'UO5�� <br /> to z0 9 CPO("V 'Qi)se- a s ' <br /> SIGNATURE <br /> Notary r�-6 —ri <br /> Barnstable ss. <br /> f�� / N Da� <br /> Personally appeared before me the above named ' " i ` ` �S and made oath <br /> that the foregoing statements are true. <br /> r / <br /> me-Notary P blie'-- <br /> Commission Expires <br /> Origform/Discontinuance <br /> I` <br />