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TOWN OF MASHPEE <br /> Statement of Discontinuance,Change of Residence,Change of Location of Business, <br /> Withdrawal,or Deceased from Business or Partnership,Chang of Business Name or Owner Name <br /> 7ali�R, ;uI4 <br /> DATE <br /> The Town is desirous of going"Green" as much as possible. To that end, please include your email address. <br /> Emnil 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 d clare(s) that Me has (have) this day discontinued (retired <br /> from) (withdrawn from)the business of V1 A; 1!'!N DCI—fr� (rte <br /> conducted at gttivwlCP►��nte" <br /> STREET <br /> I <br /> SIGN TUR <br /> Change of Location of Business <br /> 1 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 /> 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 /> Bamstable ss. <br /> Date <br /> Personally appeared before me the above named and made oath <br /> that the foregoing statements are true. <br /> • Name-Notary Public <br /> Commission Expires <br /> Origfonn/Discontinuance <br />