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O\rN <br /> ,\\\f. ...OSA, <br /> uy <br /> TOWN OF MASHPEE <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 <br /> Owner Name <br /> OC )e,_ �4 900 rp <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:l ,si,UI r�7RJ P/SrJ C`XL��S'/CLJ 7g70_,Y. Cork, <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 hereb eclare(s) that 1/We has (have) this day discontinued (retired <br /> from) (withdrawn from) the business of ons•eS �JY {It^m droyleMO- . <br /> conducted at <br /> STR"4 <br /> ®® <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 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 S - <br /> to C,hc� � S • So��'t°S <br /> SIGNATURE <br /> Notary �n <br /> Barnstable ss. <br /> �i/ Date <br /> Personally appeared before me the above named V/.S nd made oath <br /> that the foregoing statements are true. <br /> • Deborah Dam' <br /> r <br /> e <br /> NOTARY PUBLIC Name-Notary Public <br /> Commonwealth ati es Jury usetts Commission Expires <br /> My Commisslon Ex <br /> Origform/Disconti nuance <br />