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v <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 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: <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 declaLe�(s)�th�t I/We h s (have) this day discontinued (retired <br /> from) (withdrawn from) the business of f %`� C l9/ <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 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 O I <br /> Barnstable ss. <br /> Date <br /> Personally appeared before me the above named I f I f 1�r h and made oath <br /> • that the foregoing statements are true <br /> Name-Notary Public <br /> i rl <br /> ° - Commission Expires <br /> Origfo n/Discontinuance <br />