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4 7 <br /> � p.,o'. .ice '•.Li Y <br /> TOWN OF MASHPEE <br /> Statement of Discontinuance, Change of Residence, Change of Location of Business, <br /> Rts 41.c co rh" Irawal, or Deceased from Business or Partnership, Change of Business N.me or Owner Name <br /> 3C i, V <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: <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 decla e(s) tJ� at 11 has (have) this day discontinued (retired <br /> from)(withdrawn from)the business of ,��t dz,r ooi2�ih, ate` <br /> conducted at �7 '' <br /> STREET i <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 /> • <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 /> t0 <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 gform/Di scontin a an ce <br />