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Off:/.•• �!ly <br /> �. <br /> •C,'e� ��. 'TOWN OF MASIIPCsP <br /> Slatemenl 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 /> c_ a aooq <br /> DATE <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 1/We has (have) this day discontinued (retired <br /> from) (withdrawn from)the business of <br /> i <br /> conducted at <br /> STREET <br /> i <br /> i <br /> SIGNATURE <br /> I <br /> i <br /> i <br /> Change of Location of Business <br /> 1 hereby state that the location of the business/my residence as it appears on the Business Certificate filed <br /> Oil has been changed to <br /> Name of Business <br /> I <br /> SIGNATURE <br /> I <br /> I <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 front <br /> to <br /> NATURE <br /> Notary <br /> Barnstable ss. <br /> — --------------'---'------- '---------/-- --Date--"---------------------- <br /> Personally appeared before me the above named S/ "r `5o o and orad- oath <br /> • that the foregoing statements are true. <br /> Deborah Dami <br /> ° NOTARY PUBLIC <br /> Name• tart'Public <br /> Commonwealth of Massachusetts <br /> My Commission Expires July 29.2016 Commission Expires <br /> Orie form/D i scop i n uance <br />