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d <br /> ,y <br /> ,x TOWN OF MASHPEE <br /> Statement of Discontinuance Change of Residence Chan <br /> ' co ,.. g a of Location of Business g <br /> Withdrawal,or Deceased from Business or Partnership, Change of Business Name or Owner Name <br /> S v o -� 4 <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: n-z--ty <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 from) (withdrawn from) the business of �� � <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 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 /> Ori g form/Discontinuance - <br />