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TOWN OF iVIASHME <br /> o9 w5y� Statement of Discontinuance, Change of Residence, Change of Location of Business, <br /> Rt�tiiiiCec�`� - Irawal,or Deceased from Business or Partnership, Change of Business Name or Owner Name <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: OLOAJ-ammR i �" cock @ oAl • C'bn, <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 from) (withdrawn front) the business of 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 <br /> to <br /> SIGNATURE <br /> Notary <br /> Barnstable 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 /> i; Commission Expires <br /> Ongform/Discorin numue <br />