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quti or, n� � d ©� <br /> W Im TOWN OFIVIASHPEE <br /> Statement of Discontinuance, Change of Residence, Change of Location of Business, <br /> R `.. <br /> h-:nval,or Deceased from Business or Partnership, Change of Business Name m-Owner Name <br /> 1 <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: [eel I 6(L))- <br /> fscontinuance <br /> In conformity with the provisions of Chapter one undyed and ten, section five, of the General <br /> Laws, as amended, the undersigned hereby declare(s) tht e has (have) this day discontinued (retired <br /> from) (withdrawn from) the businees,ss of _,-K �i 1Yu <br /> conducted at �_ M I I)_x `�rm po� <br /> STREET <br /> SIGNATURE V <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 /> O ri gfonn/D scon l i n uance - <br />