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A"I?011'H ap <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 /> jy\4 ti a!7K"t')..0 <br /> 1!S- <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: x enwsr VAQ_ - Vf Y�c7YV\ <br /> I <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 de c ares) that I/We has (have) this day, discontinue retired <br /> from) (withdrawn from)the business of r�ra� Mo�a2.c�Cern � <br /> conducted at 2OO <br /> STREET <br /> SIGNATU 151, <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 Y P vw.en F. �0.(SVe C and made oath <br /> that the foregoing statements are true. <br /> Name-Notary Public <br /> Commission Expiresvp <br /> /3D� a /9 <br /> OrigforndDiscontinuance o <br />