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j TOWN OF MASHPEE <br /> Statement of Discontinuance,Change of Residence, Change of Location of Business, <br /> Withdrawal,or Deceased from Business or Partnership,Change of Busi ss Name or Owner Name <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: M Md u1 v—T� ITC, CO/"t <br /> Discontinuance <br /> l co ormity with the provisions of Chapter one h df'ed and ten, section five, of the General <br /> Laws, as amended-,,he undersigned hereby declare at I/We has (have) this day discontinued (retired <br /> from) (withdrawn fro the business of <br /> conducted at <br /> STREET _ <br /> SIGNATURE <br /> Change of�e�siidenceas <br /> I hereby state tha e location of the business/ it appears on the Business Certificate filed <br /> on has been changed to <br /> „• Name of Busi <br /> SIGNATURE <br /> f <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 —A y r 1—� �l <br /> to R-*P-4" / . / <br /> SIG URE <br /> Notary <br /> Barnstable ss. <br /> n Date <br /> Personally appeared before me the above named Lr. $�N /"/URPI r and ma <br /> that the foregoing statements are true. <br /> • .��� <br /> arch-Not4ffRdHllc MAZ2UCCMELLI,JR ' <br /> e <br /> 1LTH OF MASSACIIUBE <br /> Commission Fires- <br /> _ October 23.2013, <br /> Ongform/Discontinuance - <br />