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�``V.(OWN OA-4 <br /> 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 from)(withdrawn from)the business of 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 /> 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 nam`a of <br /> the business or the owner as it appears on the Business Certificate has <br /> been changed <br /> ////,,ff(1 from <br /> '] ff�1 " L c/�J% rc� �) I 1u S� �6yl Po <br /> to u�r-YNLJ (.._ Te. E <br /> SIGNATURE <br /> Notary <br /> Bamstable 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 /> Origfonn/Discontinuance <br />