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Y tOwNU� ,p j <br /> f mt TOWN OF NIAMPEE <br /> Statement of Discontinuance, Change of Residence, Change of Location of Business, <br /> M 17 crawal,or Deceased from Business or Partnership, Change of Business Name or Owner Name <br /> DATE <br /> The Town is desirous of going"Green" as /m(uf ch as possible. To that end, please include your email address. <br /> Email Address: S�Gy �$C,/e°Lti(S�V Skp.L—(7'�'/� CAS_. <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( that I Ve as (have) this day discontinued (retired <br /> from) (withdrawn from) the business of 7 2( <br /> conducted at 3<,' 1 C o A0 . <br /> STREET <br /> SIGNATURE <br /> Change of Location of Business <br /> I hereby state that the location of the business/my residence as it appearon 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 /> On-form/Discontinuance <br />