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• TOWN OF 1VLkSHPEE <br /> '�AUI,a LO" <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 /> 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 VWe 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 from)(withdrawn from)the business of 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 /> xz 6Mq <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 a_n�� r ' n�>,l_�N2IOZI "C <br /> �b <br /> SOA --S <br /> Notary <br /> Bamstable ss. <br /> Date <br /> Personally appeared before me the above named IC lC161 aA�t ��q oath <br /> that the foregoing statements are true. c <br /> �Pu <br /> Commission Expirei <br /> ` <br /> OrigfornvDiscontinumceOF- >H 5 <br /> it Pile�\``` <br />