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2610-G32 <br /> own <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 /> DATE <br /> The Town is desirous of going"Green"as much as possible.To that end, please include your email address. <br /> Email Address: koUCkUr,r-,iA Cho+mail ,Corel <br /> iscontinuance <br /> In conformity with the provisions of Chapter one hundred and ten, section five, of the General <br /> Laws, as amended, the undersigned hereby declares) that I/We has (bave) this day discontinued (retired <br /> from) (withdrawn from)the business of Iced Llin Felt✓ <br /> conducted at 35 Skorc hr. V454., MCL-S yo�e R 07-10L4 J <br /> STREET <br /> SIGNATURE <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 /> I <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 � g.c,V gl <br /> Barnstable ss. <br /> Date <br /> Personally <br /> Personally appeared before me the above named CQ ` ' —06n1-e11and made oath <br /> that the foregoing statements are true. <br /> . r Name-Notary Public /l <br /> Deborah Dami <br /> NOTARY PUBLIC <br /> Commission Expires <br /> Commonwealth of Massachusetts <br /> Origfonn/Discontinuance My Commission Expires July 29,2016 <br />