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00 <br /> O4 <br /> 1 M TOWN OF MASHPEE <br /> `-`'°.`�--{-r ,.•�`'' Statement of Discontinuance, Change of Residence, Change of Location of Business, <br /> stnn�c co� Irawal, or Deceased from Business or Partnership,Change of Business Name or Owner Name <br /> �y -ii/ <br /> DATE <br /> The Town is desirous of going"Green" as/much <br /> �as possible. To that end, please include your email address. <br /> Email Address: ) M O ( (a i1 <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) that I/We has (have) this day discontinued(retired <br /> from) (withdrawn from) the business of <br /> conducted at <br /> STREET <br /> SIGNATURE <br /> Change of Location of Business <br /> I hereby state thatthelocation of the business/my residence as it appears on the Business Certificate filed <br /> on UdAd ' r "),MU has been changed to <br /> Name of Business d) <br /> kt �a yM oit /yl <br /> SIGNATURE <br /> Change of Name of Business or Owner <br /> 1 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 /> Dale <br /> Personally appeared before me the above named and made oath <br /> that the foregoing statements are true. <br /> Nane-Notary Public <br /> Commission Expires <br /> OndormIDiscontinuance <br />