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03-24-'14 15:27 FROM- T-039 P0002/0002 F-116 <br /> S <br /> r ) TOWN OF MASHPFE <br /> � Statement of Discontinuance,Change of Residence,Change of Location of Business, <br /> Withdrawal,or Deceased from Business or Partnership,Change of Busin�eesss Name or Owner Name <br /> DATE <br /> The Town is desirous of <br /> going"Green"as much as possible.'fo that end,please include your email address. <br /> Email Address,_ &1:16 G. ee wI <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 from)(withdrawn from)the business of li' CGR3S/C B�t7CF13ii)� TNGS <br /> conducted at <br /> STREET <br /> G'Gosc� /��•�/� oia2 <br /> NATURE <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 ow-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 fi•om <br /> to <br /> SIGNATURE' <br /> Notary <br /> Barnstable ss. pate <br /> Personally appeared before me the above named and made oath <br /> 10 that the foregoing statements are true. <br /> J Name-Notary Public <br /> Commission i1xpires <br /> OrigfomdDiswmimnmcc <br />