32C-219 (14) THE COMMONWEALTH OF MASSACHUSETTS ST
Statement of Discontinuance, Change of Residence, Change of Location of Business,
r ` Withdrawal, or Deceased from Business or Partnership.
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In conformity with the provisions of chapter one hundred and ten, section five, of the General Laws, as
amended, the undersigned hereby declare(s) that........................has (leave) this day discontinued (retired from)
(withdrawn from) the business of
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...............•--....---•--•----•.--...............----...................... ....... ...........-................. ........ .-.._ .............................................................
conductedat ...........................................................---------- .................................. ------•----•-------------------•---------------------------- Street
inthe city or town of..........................................--........................... ---- --------•---..... .------------------------------......---------...---------------...-
as set forth in certificate filed in the office of the Clerk of said city or town on....................................................................
Name Address
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SIGNATURE
the business
I hereby state that the location of as it appears on the Business certificate of
...Five_..Five...Taxi.,....In.G........................................ ..................... -•---•........•-••........
filed on...February 9 ---------------- ----- -- ---19.89-......
..................................
has been changed to..-.123 Hawley Street Northampton, Mass.
from: 23 Service Center Road, Northampton, Mass.
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....... ...... d-7r:C?.....-....r ......... .GCr{Z. !S�.`.G.............................................
SIGNATURE
By Estate
ill oft
of
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Executor under the
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...... .............................................................Ss. ----- ....................................................... 19...........
Personally appeared before Ine the above-named............................................•-------......--••-•--•------------------------------------
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and made oath that the foregoing statements are true.
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(SEAL)
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e. TbT E I
Tt-k .
FORM 496 HOBBS& WARREN, INC. PUBLISHERS
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