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Y. <br /> TOWN OF bLkSHPEE <br /> • Statement of Discontinuance,Change of Residence, Change of Location of Business, <br /> Withdrawal, or Deceased from Business or Partnership, Change of Business Name or Owner Name <br /> 7'�� <br /> DATE <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 de lare(s) that I/We has have) this day discontinued (retired <br /> from) (withdrawn from)the business of r-.0 9/ <br /> conducted at l gt.t Mcg MCt- 02-&V7 <br /> STREET <br /> SIGNA <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 /> • <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 /> Daze <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 /> OngfonNDiscontinuance <br />