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c?D07— <br /> - � -N i M TOWN OF MASHPEE <br /> '• ....'hy' Statement of Discontinuance, Change of Residence,Change of Location of Business, <br /> R,y <br /> �iiiitc co�• T Irawal,or Deceased from Business or Partnership, Change of Business Name or Owner Name <br /> l7 Jy amid <br /> DATE <br /> The Town is desirous of going"Greed' as much as possible. To that end, please include your email address. <br /> Email Address: Fir•- ��(� u.� /�f'J' CD rvl <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 declareO that Me has (have) this day discontinued (retired <br /> from) (withdrawn from) the business of ✓9 A S h P f C J�; <br /> conducted at <br /> a <br /> STRE <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 /> 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 /> • a <br /> Name-Notary <br /> Public <br /> Commission Expires <br /> I <br /> O r i g fo rm/D i s co n t i n u a n ce <br />