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TOWN OF MASHPEE <br /> • e9•"°.�-= , : 5�' Statement of Discontinuance,Change of Residence,Change of Location of Business, <br /> q ............... -,�5 <br /> s7;tur�-�o• 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; <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 ay discontinued (retired <br /> from) (withdrawn from)the business of LCeU� C�M 1 �^ <br /> conducted at �I Sc c�QCLC,y ec <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 /> Ongfonn/Discontinuance <br />