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TOWN OFNIASHPEE <br /> • 3,J{U �r/ayy_ Statement of Discontinuance,Change of Residence,Change of Location of Business, <br /> :c...... <br /> `� Irawal, or Deceased from Business m' 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 from) (withdrawn from) the business of 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 /> has been changed to <br /> on <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 TU)e Af 5 RN-E RAJAML)OK11 S FS / f I'LL - <br /> toLG I AHI.LL° t(/boi— box /v 70,4A <br /> SIGNATURE <br /> Notary d <br /> Barnstable ss. <br /> ` Date <br /> Personally appeared before me the above named <br /> �— and made oath <br /> that the foregoing statements are true. ��� <br /> • �, VICKI ANN GOVONI \ Name-Notary Public <br /> Notary Public <br /> f141($ty COMMONWEALTH OF MASSACHUSEi79 Commission Expires <br /> My C.on mission NIBS <br /> ,ply 19.2013 <br /> OngforndDiscontinuance ' <br />