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'�m�. o2UG7-655 <br /> - <br /> � ��\�` Mt TOWN OF MASHPGL <br /> Statement of Discontinuance, Change of Residence, Change of Location of Business, <br /> R <br /> 'vs7eiiiti;'�o`� Irawal,or Deceased from Business or Partnership,Change of Business Name or Owner Name <br /> WVI�. r <br /> 710 I <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: <br /> Discontinuance <br /> Li conformity with the provisions of Chapter one hundred and ten, section five, of the General <br /> Laws, as amended, the undersigned hereby declare(s) tl at 1/We has (have) this day discontinued (retired <br /> from) (withdrawn from) the business of ern � <br /> conducted at <br /> STREET <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 /> Oil has been changed to <br /> Name of Business <br /> SIGNATURE <br /> Change of Name of Business or Owner <br /> T 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 /> Persona11jD(3pqjVredAeQWW meld?e above named and made oath <br /> that the fore.-oing statements are true. <br /> • . . . <br /> A-1-10 MM01 - Name-Notary Public <br /> 33dHSVW 30 U01 <br /> Commission Expires <br /> Ori_fprm/Discontinuance <br />