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TOWN OF MASHPEE <br /> m5h - <br /> �`SIAOLC-CO'� - <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 /> / O <br /> - ATE - <br /> Discontinuance <br /> In conformity with the provisions of Chapter one hundred and ten, section five, of the General 1 <br /> Laws, as amended, the undersigned hereby declare(s) that I/We has (have) this day disco=tired <br /> from) (withdrawn from)the business of R rJ <br /> conducted at <br /> STREET <br /> (S//Vtic0 7t <br /> SIGN URE <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 (/ g f - <br /> . ,gip <br /> ey "C <br /> Change of Name of Business or Owner �Eye9 �a14�, <br /> I hereby state that the name of the business or the owner as it appears on the Business Certificate has <br /> tit <br /> been changed from <br /> to <br /> SIGNATURE - <br /> Notary - <br /> Barnstable ss. <br /> Date <br /> v <br /> Personally appeared before me the above named d�� n made oath <br /> • that the foregoing statements are It <br /> Name-Not ubli� . a ;2o(7 <br /> Commission Ex-pi's7 <br /> Origform/Discontinuance ,. <br />