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,-w q—��A <br /> 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 /> Ft& I, 201 '3 <br /> DATE <br /> The Town is desirous ttyyo��f going"Green"as much Gass possible.To that end,please include your email address. <br /> Email Address: Bob t i ct are r Y�J-mi41 h1 j4� t- (0 M <br /> Discontinuance,J <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 from) (withdrawn from)the business of 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 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 C I a wer 1 nes u r'an e� , rn�n <br /> to o l o ire ww4fi /yLa n aynti•ce <br /> SIGNATURE <br /> r2 11 -31 Z <br /> .- . ._..... . �� Notary / <br /> Dale <br /> Personally appeared before me the above named and made oath <br /> that the foregoing statements are true. - - - <br /> Ew <br /> Name-Notary Public TfurTirwrt <br /> BORCHERS <br /> Commission Expires Mauvyl%ift <br /> Carawmedth Ol MMMChuMts <br /> 4b0wmss=EVm <br /> Ongform/Discontinuance NOM*a 28.2019 <br />