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01"Towly 0r'rr <br /> 0.41. <br /> -7 <br /> �,\•, rte"^\ TOWN OF MASHPEE <br /> oLa c Statement of Discontinuance,Change of Residence,Change of Location of Business, <br /> • Withdrawal,or Deceased from Business or Partnership,Change of Busi ess N me or Owner Name <br /> l2116107 <br /> DAT <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 declate(s) that I/We has (have) this da di; ontinueedretired <br /> from) (withdrawn from)the <br /> //business of _- � ��— fi <br /> conducted ata//y <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.Sir E 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 y Cti <br /> to J / <br /> SIGNATURE <br /> Barnstable ss. Notary <br /> DL <br /> Personally appeared before me the above named e � S �' �w�'�—and made oath <br /> that the foregoing statements are true. <br /> • Name-Notary Public <br /> ary Public <br /> Origfomr/Discontinuance COMMONWEALTH OF MASSAC <br /> My Commission Expires <br /> 025 2013 . <br />