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to WN <br /> ur ttv <br /> �.. i TOWN OF NLUBPEE <br /> • `�tAULC Cp.. <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 I/We has (have) this day discontinued (retired <br /> from)(withdrawn from)the business of %Hr rYO T7a)(r <br /> conducted at 27 E�4,F— <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 /> • <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 fromEG �7��— <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 /> OrigfomvDlscontinuance <br />