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t. eil A <br /> TOWN OF MASHPEE <br /> Statement of Discontinuance,Change of Residence,Change of Loca ion of Business, <br /> Siriu�c co Irawal,or Deceased from Business or Partnership,Change of usine Name or Owner Name <br /> � a > <br /> TE <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 (have) this day discontinued (retired <br /> from) (withdrawn from)the business of .SU.JSA'O +W4- -MJA.w 1 LCC <br /> t-A <br /> cond�u`ctedd at S CLIaS Q <br /> Pp�cn,. l-Y. P/'�VLIS CORI . STRE <br /> abq S/JNS(�l`�aa.A\.-.TAt,iNiaG <br /> GNATURE <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 /> On gform/Discontinuance <br />