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Opo <br /> {)� <br /> TOWN OFMASHPEE <br /> ¢co <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: <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 VWe 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 from) (withdrawn from)the business of 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 /> 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 �! KZA 94 6k?) Ih/ <br /> to C Lao-�A <br /> ,SIGNATOR <br /> Notary CJZ I!l�c. dtg OHO/J <br /> Barnstable ss. <br /> Dante I <br /> Personally appeared before me the above named �IYI a ' ' `I T!�S �ly � M ��L d made oath <br /> that the foregoing statements are true. <br /> . b Notary-Public Name- otaryPublic <br /> `- Margaret C.Santos <br /> � Commornvealth of Massachusetts Commission Expires <br /> My Commission exphes on Sept 22,2017 <br /> Origform/Discontinuance <br />