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4 pBA <br /> TOWN OF D4ASHPEE <br /> o,°.;a- -••'S�. - Statement of Discontinuance,Change of Residence,Change of Location of Business, <br /> Rtis/�iufi:;c�`� Irawal,or Deceased from Business or Partnership, Change of Business Name or Owner Name <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: �"G(hUS (CLyI /(N Lq'(�Q.II• CQ,/� <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 discontinue (retirefl <br /> from) (withdrawn from) the business ooftJ F1 00'L COV-P n,�� , pr�L � Q IYZi� L <br /> conducted at �l � rS' 40 <br /> STREET-�...�. <br /> I <br /> • ) 1 /�/ SIGNATURE <br /> Change of Location of Business <br /> I hereby state that the location of thee business/my residence as it appears on the Business Certificate filed <br /> on r- n1 _d)2: hGH id)3S J i� has been changed to <br /> Name of Business <br /> i_S <br /> r <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 fromto <br /> SIGNATURE I 5 <br /> Notary C70 <br /> Barnstable ss. <br /> r Date <br /> �y <br /> Personally appeared before me the above named `LJ h\UAd1C7\6r r(; and made oath <br /> that the foregoing statements are true. <br /> PAULA�J�YANNIC <br /> ptOTppY PUBLIC Name-Notary P\11lic <br /> 'rpMMpUly@AI.1'H OF M19SAplU6ETT3 <br /> My OOlaiil.EMpifes JUfl611,2015 Commission Expires— <br /> Jw,L-�- l(, 90G <br /> O n gform/D i sconti n u once <br />