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$8Q PER RENTAL/�.EASE LTNIT. Complete this form and return to the Health
Office. Checks gayable to; ��TURVN OF YARMOUT�'?. �'or adtiitionai F(3FtMS
ANDf(3R QVESTIOI�IS, co ���A�..T.�_..Q�._FFICE?�T�,SD8.=39.$-2231 x124Q���.
1VION—FRI,8:30 AM-4:3a 1V�. -0R- REGiSTER f31Y LINE�or$70 per ttnit,
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Rentsl Property Address
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Tenant(s}Name(s�;(If Annual Rental) Email ar Phone#
R�ntal A ent;(if y) � Email or PhQne#
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Own�r'Name (Req ' ed Info) Emai�or Phone#{Required}
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Mailing Add ess C ty/Town State �,� ,��P_. .. _... ,
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-�-� Rental Periad: Annual�, Seasona� (Winter-Summer),�Vee, '.
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Rental'af. House Duplex Apar�ment Cvndaminium ' I�oom
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--Smoke Aetectars and Carbon Manaxide Uetectors Rcquired=
Operable smoke and carbon monoxide detectors are reqaired at each habitable level and in basements urith
any applian.ces:using fc�ssil' fuels;(oil, gas, kerosene}, including coal or wood stoves and enciased or
attaehed garages_ Owners: Have�vu ensured the batteries are chang�l,and have tested ALL yflur
Smoke De�ctorsl�arbon Ma�o�de Detectors?
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PENALTIES — Late registrativn of mvre than 3U DA�S after r�eipt or vialations of any
part o�Chapter 1U8,m.a�y be sul�ject to non-criminal citations i�ss��d as fi�llows. Each day's
vivlation deemed a separate offense. 1Sc Q�fense $50A012"�flffense $1QOAU/ 3fd Offense
` (and each adclitional�$20Q►.�: This appiies to any "O�VNER?r,"A�ENT" OR "TEN��NT"
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Trash Remo�al by: Qwner�,� Tenant Disposai�vlSti�ker at��:�
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Paid Piekug Name of C�mpany : � �
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��INSPECTION OF ALL UNITS ARE REQUIRED!�� -
�� Please call to schedule 508-398-2231, ext. 1240 . �.;T ��
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,�ti`� ���' ;�`� �:' 2017 RENTAL/LEASE REGISTRATION ��AN �4 2017
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.�('�r,; � TOWN OF YARMOUTH - BOARD OF HEAL H
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�� 1146 ROUTE 28, SOUTH YARMOUTH MA 02664 r
Register on line and SAVE $10 per unit @www.yarmouth.ma.us (Online Services)
'�-�ATTENTION LANDLORDS of Houses, Apartments, Duplexes, Condominiums and
Room Rentals (in owner occupied dwellings). Excluding Hotel/Motel, Inn, Lodging
House or Bed and Breakfast operations. (CHAPTER 108 - OCCUPANCY OF
BUILDINGS BYLAV�. Note: Compliance with Zoning regulations is not inferred, nor
intended.
- --- �--���-��f�EA�E �egist�ations EXPIRE on DECEMBER 31 of each year.- FEE IS
$80 PER RENTAL/LEASE U1VIT. Complete this form and return to the Health
Office. Checks payable to: "TOWN OF YARMOUTH". For additional FORMS
AND/OR QUESTIONS, contact the HEALTH OFFICE AT 508-398-2231, x1240,
MON-FRI,8:30 AM-4:30 PM. -OR- REGISTER ON LINE for $70 per unit.
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Rental Property Address
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Tenant(s) Name(s) (If Annual Rentai) Email or Phone#
Re 1 Agent (if ny) � Email or Ph e#
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� Owner ame (Re uired fo) .; Email or Phone# (Required)
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Mailing ddress Cit own State _ ZIP
Rental Period: Annual�, Seasonal (Winter-Summer}, Weekly
Rental of: House Duplex, �' Apartment Condominium Room
--Smoke Detectors and Carbon Monoxide Detectors Required—
Operable smoke and carbon monoxide detectors are required at each habita.ble level and in basements with
any appliances using fossil fuels (oil, gas, kerosene), including coal or wood stoves and enclosed or
attached gazages. Owners: Have you ensured the batteries are changed,and have tested ALL your
Smoke Detectors/Carbon Mono�cide Detectors?
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� '� Signature
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���; -` r�r��Y (Required)
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PENALTIES - Late registration of more than 30 DAYS after receipt or violations of any
part of Chapter 108, may be subject to non-criminal citations issued as follows. Each day's
violation deemed a separate offense. lst Offense $50.00 / 2nd Offense $100.00 / 31d Offense
�' �ana each adai�ional� $�O�.O�i. Tius applies to any "OWNER","AGENT" OR "TENANT"
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Trash Removal by: Owner� Tenant Disposal w/Sticker at Landf'ill
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Paid Pickup Name of Company
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