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�Iltoo <br /> 1 M TOWN OF MASHPEE <br /> 5� Statement of Discontinuance, Change of Residence,Change of Location of Business, <br /> IIsi,iiiLE co- Irawal, or Deceased from Business or Partnership, Change of Business Name or Owner Name <br /> x26/0 <br /> DATE <br /> The Town is desirous of going "Greed' 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 decl re(s) that I/We has (have) this day discontinued (retired <br /> from) (withdrawn from) the business of a c t / q <br /> conducted at J1 <br /> l� 8 S4, 4I?.9s1✓�cz /M Dal V q V AS419+x�uom��:� <br /> rREET <br /> ^Ak. <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 /> Oiiatoim/Discontinuance <br />