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i <br /> cn+rn �Q(7�•U •�' 1 <br /> S \y <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 /> Dt f 1 <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 declares) that I/We has (have) this dyy discontinued (retired <br /> from) (withdrawn from) the business of 2 61 3 Tib l» /I�SS.'l�!//rrc e Sal✓ho y <br /> conducted at 4)Q <br /> STREET <br /> SIGNATUR <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 /> 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 /> Name-Notary Public <br /> Commission Expires <br /> Ori gform/Discontinuance <br />