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w' Town W. <br /> TOWN OF MASHPEE <br /> yy <br /> Statement of Discontinuance, Change of Residence, Change of Location of Business, <br /> Withdrawal, or Deceased from Business or Partnership, Change of Busin ss Na a or Owner Name <br /> Y a l <br /> DATE <br /> The Town is desirous of going "Green" as much as possible. To that end, please include your email address. <br /> Email Address: <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 d lare(s) that I/We has have) thi, day discontinued (retired <br /> from) (withdrawn from) the business of 4Yb'3//�fy /YJA <br /> conducted at 'Cev <br /> STREET t� <br /> i <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 /> onhas 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 /> Namc-Notan,Public <br /> Commission Expires <br /> OrigibmilDiscomi nuance <br />