HomeMy WebLinkAbout37 Clifford Street paper applicationAppf ication for 2024 Rental Registration
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664Telephone (SO8) 398-2231 , ext. 1240
Fax (SO8) 760-3472
E-mail: epol ite@yarmouth.ma. us
t-httDs ://varmouthma.portal.openqov.com/
nd conveniently pay the registration fee.
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A non-refundabteapptication fee of $80 pef Unaufental is requrred
Rental Certificates expire on December 31"1, 2024.
If NOT registering online, please make checks payable to: Town ofYannouth and mail completed application &
payment to: Town of Yarmouth Health Deparlment.
icatiou and feeThe Health Department willcaltto sctledule an inspection if required, upon receipt of youra
Rental Property lnformation
All fields are uired! lncom lete forms ithout a valid hone # or email cannot be sed
Rental Property Address
b'7 CtrFFor\Sr *.0 . Rental Period
l_11 Seasonal_ Short Term (less than 31 days)A*nu^
Trash Removal bv
owner- -"n"*r,/
7 Rental of
,/House Duplexa Condo Apartment Room
-E{pperty Owner Name'!r@47 {S^u,tN. €Mailjr ins Address O 40FAtfiu% 9. l*<^lrril 4*(requrred)Pnmary Phone No
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Alternate Phone No (required)E/nail Address
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owner's Representative/RentalAgenUAgency Primary Phone No (required)E-m;il Addiess
the Health Department in writing when I am no longer renting the property. or I may be
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