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� <br /> Or.qJ, <br /> TOWN OF MASHPEE <br /> Statement of Discontinuance,Change of Residence, Change of Location of Business, <br /> Rt ;ii7i; cu`� Irawal,or Deceased from Business or Partnership, Change of BusinessName or Owner Name <br /> vx.l n,r..r A 20 \1 <br /> TE <br /> The Town is desirous of going n"Green" as much as possible. To` that end, please include your email address. <br /> Email Address:�arioarak., I� ;Me '��fno \ .cofn <br /> U <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 from) (withdrawn from) the business of np Qzerx A0co S Ra5A-"y r,�— <br /> conducted at — R FaAI /\CO-- `� 51-f A -1 <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 N�5 r ^ �" has been changed to <br /> • Name of Business <br /> SIGNATURE <br /> Change of Name of Business or Otrner <br /> I hereby state that the name of the business or the owner as it appears on <br /> the Business (Certificate has <br /> been changed from Fit c-11 C-' (7Ox p A b e-- (f aL6 ` �fel a J0 C <br /> to bjd r O <br /> SIGNATURE <br /> Notary <br /> Barnstable ss. <br /> _ Date <br /> Personally appeared before me the above named C and made oath <br /> that the foregoing statements are <br /> �true. <br /> � �f11 <br /> • _ �b OM' amc-Notary 1` is <br /> ° NOTARY KMUC <br /> ^'� CpmmppwpMdl Commission Expires <br /> Origfann/Discou nuance <br />