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t6,prorvn.ort <br /> �9 <br /> Wig IT�(\"= .,-S/ TOWN OF MASHPEE <br /> nuc c <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 /> to -a-3 <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 declares) thatag has ave) is day discontinued (retired <br /> from) (withdrawn from) the business of Ttl <br /> conducted at <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 as. <br /> Date <br /> Personally appeared before me the above named -D1-�fye �P—�U and made oath <br /> • that the foregoing statements are true. <br /> Name-Notary Public <br /> Commission Expires 9/ <br /> OriglormiDiscontinuance <br />