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y y. <br /> C TOWN OF MASHPEE <br /> �o• 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 Me 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 from) (withdrawn from)the business of 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 /> i <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 /> toL_ G.r/J <br /> SIGNATURE <br /> Barnstable ss. Notary Car,-I k_", a P c301 1' <br /> Date <br /> Personally appeared before me the above named ak' s k l 1"° L n 'c GtS and made oath <br /> that the foregoing statements are.true. <br /> • Notary Public V y ` J <br /> Margaret C.Santos Name-Notary Public <br /> l;ommonwealth of Massachu�2017 <br /> My Commission Expires on Sept• Commission Expires <br /> OngfomJDiscontinuance <br />