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v <br /> s �3� jr 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 /> / or .7(0/3 <br /> DATE <br /> The Town is desirous of going"Green" asmuchas possible.To that end,please include your email address. <br /> Email Address: a/!<�.�V�IDGC HAI 16. MOO <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 declares)�t t I/We has (have) this day discontinued (retired <br /> from) (withdrawn from) the business of ole�it <br /> conducted at a+3 A�`t17Carooi� �IKetc� /��SN cs�dl49 <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 /> { SIGNA <br /> f' <br /> NotaryBarnstable ss. <br /> Date <br /> Personally appeared before me the above named A F, ��_and made oath <br /> • that the foregoing statements are true. — <br /> N me- taei,(PS&Wld MAllUCCM.176—K—i. NotafyMlic EW,J <br /> C - �'C�"geWEAUM OF MA8&1dp18ET(S <br /> /'��� MyOctoW25. Ewi�' <br /> OctaOer 2S,7079 <br /> on gforndDi sconti nuance - <br />