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Ih <br /> •�.ti �\\yYCU,\�15yY prl . <br /> 04 ~may <br /> 7. <br /> TOWN OF DIIASHPEE <br /> Statement of Discontinuance,Change of Residence, Change of Location of Business, <br /> T <br /> Y�n'u'i;e co-`n Irawal,or Deceased from Business or Partnership, Change of Business Name or Owner Name <br /> DATE <br /> The Town is desirous of goin "Greed' as much as possible. To that end, please include your email address. <br /> Email Address: Qsp(�WC "'viL. <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 Me 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 from) (withdrawn from) the business of 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 <br /> I hereby state that the location of the business/my residence as it appears on the Business Certificate filed <br /> on ?f ll� T mkN IuC. has been changed to <br /> • <br /> 36 <br /> Name of BPQess 1 <br /> is <br /> SIGNAT <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 /> c re• f pA'jj <br /> SIGNATURE <br /> Notary <br /> Barnstable ss. 17 <br /> Date <br /> Personally appeared before me the above named — 8nd made oath <br /> that the foregoing statements are true. <br /> LORRAINE CARREIRU ame-Notary,Pµblic <br /> NOTARY PUBLIC /�_ �5 _ `J <br /> Commonweallh of Massachusatis <br /> My Commission Expires Commission Expires <br /> October 15,.2015 <br /> Origform/Discontinuance ' <br />