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`ss rows or°� <br /> O4 � !) <br /> 1a �Me TOWN OF MASHPEE <br /> ��- - , �� Statement of Discontinuance,Change of Residence, Change of Location of Business, <br /> kY <br /> Ric Irawal, or Deceased from Business or Partnership, Change of Business Name or Owner Name <br /> .3�/hoz// <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 /> In conformity with the provisions of Chapter one hundred and ten, section five, of the General <br /> Laws, as amended, the undersigned hereby declare(s) thatI/ft kms (have) this day discontinued (17 <br /> *tri) (withdrawn from)the business Ofp F11nCu rA ItP- <br /> conducte �A $.SJIDEc CV /O <br /> d 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 /> 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 /> SIGNA'T'URE <br /> Notary <br /> Barnstable ss. <br /> Date <br /> Personally appeared before me the above named L411,0 A k-a d made oath <br /> that the foregoing statements are true. <br /> • <br /> Fiq <br /> ldii �Hires Notary Public0 MbNWEALTN OF MASSAg1JMU <br /> My Commission Expires <br /> Ou ofonn/Discontinuance Otiober 15,2013 <br />