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�% }m TOWN OF MASHPEE <br /> Statement of Discontinuance Change of Residence,Change of Location of Business <br /> ay`..... x� g <br /> `�noteco' Irawal,or Deceased from Business or Partnership,Change of Business Name or Owner Name <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:O ZCZ jet G 6D A e7L C�az,�— <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 from) (withdrawn from) the business of j2US tre74A Ak(te �CICS <br /> conducted at av U l 'PA H A;Lja�eA /41Vz -7-CLO <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 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 /> SIGNATURE <br /> Notary <br /> Barnstable ss. <br /> Date <br /> Personally appeared before me the above named and made oath <br /> that the foregoing statements are true. <br /> Name-Notary Public <br /> Commission Expires <br /> Ori gforndD i s Contin tan ce <br />