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.` /.�0 y <br /> Is <br /> TOWN OF MASHPEE <br /> 5 <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 /> �� I `�• 12 <br /> DATE <br /> The Town is desirous of going"Green" as Jmu�c^h as possible.To that end,please include your email address. <br /> Email Address:T— fa .bafGzt FI&kco® <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 from) (withdrawn from)the business of 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 or Name of Business or Owner <br /> I hereby state that the name of fthe business or the owner as it appears on the Business Certificate has <br /> been changed from �� Cl P I'n J� Y a— cC fbo9'11"1 r1 <br /> a 6' <br /> 7 <br /> SIGNATURE <br /> Notary <br /> Barnstable ss. <br /> Date <br /> Personally appeared before me the above named R I Vl OZ� tf and made oath <br /> • that the foregoing statements are true. <br /> �ttt F <br /> EYKMCNIIJt <br /> t on 67CfpE Ex ires2%2M` <br /> OtigfomdDiscontinuance <br />