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oeb13 - <br /> TOWN OF MASHPEE <br /> � .. <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 /> 08 <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: ` P Q 1i- EH HOVLS , C 0 H <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 from) (withdrawn from)the business of4 ter;j A14 S LC—S! 6 14 <br /> 6- IQlVeRVICV <br /> conducted at <br /> STREET <br /> SIGN RE <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 /> 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 /> SIGNA"rURE <br /> Notary 0 <br /> Barnstable ss. n Date <br /> Personally appeared before me the above named ` ' and made oath <br /> that the foregoing statements are truee..Bb�ah paMt <br /> ° WOtnohoPU �}} ge2016 <br /> Omm}eJglOt1I85 <br /> JOIy Name-Notan•Public <br /> Commission Hrpires <br /> Orig form/Discontinuance <br /> 1 <br />