Laserfiche WebLink
gON'N <br /> �4�r.i•�j�tS <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 /> a4/i <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:d-LU16, :A 410,19, G/a✓✓I lC(GSS. Cc✓+'� <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 1/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 from) (withdrawn from)the business of 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 /> 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 VV12lefC 0/ ) <br /> to o Wi/c t G. be,! 60/10&1- <br /> . <br /> SIGNATURE <br /> cS-fA./a: <br /> Of-Akilw is Notary <br /> -Bam9tftble ss. <br /> CA. 5 o f ezli-k- . Date <br /> Personally appeared before me the above named �D7 L ` C� and made oath <br /> that the foregoing statements are true. ! r <br /> 6jy Pu IC PAULSON �/ <br /> • Notary PUF.NO,ttseof Nevada Name-Notary A. <br /> nvvr.NO,Baav/a1 K. w.�Jen <br /> My Apb.Expires August 2s.2a13 Ucommission Expires <br /> Origfonn[Discontinuance <br />