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TO1"N <br /> TOWN OF MASHPEE <br /> �h <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 /> � Iy3 � 1 � <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 /> Ln 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 from) (withdrawn from) the business of 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 /> 0011 <br /> 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 / � KfF71 f /l J l3sa �� <br /> to <br /> KA- 2a( ,8l/1!V <br /> SIGNATURE <br /> \ <br /> Notary <br /> Barnstable ss. <br /> Date <br /> Personally appeared before me the above named ` -1` k--"' 'Z�>AA L [7 and made oath <br /> that the foregoing statements are true. <br /> • Nan - I y90WHL. <br /> Col I .1j511� ry <br /> WELLrhl OF MAS�,n� <br /> OrigfomdDiscontinuance a p)$ <br />