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TOWN OF MASHPEE <br /> s��,'�:�--ter • '�' Statement of Discontinuance,Change of Residence,Change of Location of Business, <br /> da 66 Irawal,or Deceased from Business or Partnership,Change of Business Name or Owner Name <br /> I-L III / Oq <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: V�aA n, 16�Y"CQMCAI&-'f /1) 5,S <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 from) (withdrawn from) the business of 012 t'Yj Ne' <br /> conducted at �Yt�l I ? Q Q <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 b b <br /> the foregoing statements are true. <br /> Name-Notary Public <br /> Commission Expires <br /> Origform/Discontinuance <br />