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I <br /> E5�/1 TOWN OF MASHPEE <br /> Statement of Discontinuance,Change of Residence,Change of Location of Business, <br /> nuu;c <br /> • Withdrawal,or Deceased from Business or Partnership, Cl t nge of Bpsiness Name or Owner Name <br /> V SOI <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) 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 from) (withdrawn from) the business of 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 stn <br /> Change of Namebf Business or Owner <br /> I hereby state that the name of the <br /> �business <br /> /o'rrthe owner as <br /> itappearson the Business Certificate has v\ <br /> been changed from <br /> to <br /> SIGNATURE <br /> Notarya"C-C-L , I a <br /> Barnstable ss. <br /> Date <br /> Personally appeared before me the above named r k ��5�`�� �� 9 oath <br /> that the foregoing statements are true. <br /> Name-Notary Public <br /> Commission <br /> N <br /> S1 <br /> Nolaiy Public <br /> COMMONWEALTH OF MASSACNU <br /> MyCamn <br /> Oriform/Dicontnuance Evir" <br /> tosion q, � <br />