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O.V/o- O y <br /> .S <br /> .�q y �• <br /> TOWN OF MASHPEE <br /> °`nnuue cod Statement of Discontinuance,Change of Residence,Change of Location of siness, <br /> Withdrawal,or Deceased from Business or Partnership, Change of Business arae or Owner Name <br /> tl <br /> D E <br /> The Town is desirous of going"Green" as much as possible.To that end,ple se incl de 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 clare(s) tIJ,I/We has (have) this day discontinued (retired <br /> from) (withdrawn from) the bus' ss of e�fly GG (� �� <br /> G � tl ul <br /> e.�:...f ... C <br /> 1 i.r <br /> conducted at <br /> y.,. <br /> Nl Lq:v STREET <br /> \�x: <br /> SIGNATURE <br /> i <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 /> j on has been changed to <br /> Name of Business <br /> SIGNATURE <br /> •a' '^t Change of Name of Business or Owner <br /> I 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 /> to <br /> SIGNATURE <br /> Notary <br /> Barnstable ss. <br /> Date <br /> Personally appeared before me the above named and made oath <br /> r that the foregoing statements are true. <br /> Name-Notary Public <br /> Commission Expires <br /> Orlgform/Discontinuance <br />