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�j O <br /> R��� 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 Business Name or Owner Name <br /> / / Zo /ZOO/ Z <br /> DATE <br /> The Town is desirous of going"Green" as much as possible.To that end,,please include your email address. <br /> l <br /> Email Address: ! r O'�I V 4LJ VOLT- 1 2-6y-\ , n e_ 1 <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 declares) t}�at UWe has (have) this day discontinued (retired <br /> from) (withdrawn from) the business of ``1�r a aid S � p <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 /> 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 the the above named and made oath <br /> that the foregoing statements are true. <br /> Name-Notary Public <br /> Commission Expires <br /> O n gform/Discontinuance <br />