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TOWN OF MASHPEE <br /> "'' Statement of Discontinuance,Change of Residence, Change of Location of Business, <br /> Irawal,or Deceased from Business or Partnership,Change of Business Name or Owner Name <br /> h? -//-/ -D 9 <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 (ha e) this day discontinued (retired <br /> from) (withdrawn from)the business of <br /> ao�s � R t iS S <br /> conducted at <br /> STREET �J <br /> SIGNATURE OBJ( <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 /> 011 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 /> ongforiuM isconti nu an ce <br />