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oF, 2, <br /> N <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 /> / �T� IV <br /> —�.9 DATE / T— <br /> The Town is desirous of going"Green" as much as possible.To that end,please include your email address. <br /> /\ <br /> Email Address: L I j- S o <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 from) (withdrawn from) the business of <br /> tconducted at <br /> STREET <br /> SIGNATURE <br /> Change of Location of Business I, <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 e, 'e. <br /> to �Pr' F f 7f�i G..c/ � . 0 <br /> � ��SIGNATURE <br /> Notary <br /> Barnstable ss. <br /> Date <br /> Personally appeared before me the above named and made oath__ <br /> that the foregoing statements are true. <br /> *A MAiZUBl.l 11,JR. <br /> f RY PUUBLIC <br /> s1VO tMWresOct le,2020 <br /> Origfonn/Discontinuance <br />