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Application tor 2024 Rental Registration
TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664
Telephone (508) 398-2231 , ext. 1240
Fax (so8) zlo-3472 RECEIVED
E-mail: epolite@yarmouth.ma.us j,\N U4 Z0Z4
The Town of Yarmouth is excited to announce that we've streamlined the online #F$fIffiPpEEI"". "make it more user-friendly than ever before! Simply visit hftps://varmouthma. oortal.openoov.com/ to get
started. There, you can effortlessly create your account and conveniently pay the registration fee.
Using this upgraded system, you'll have the power to engage with us throughout the entire process. Not only
can you securely communicate with our team, but you'll also gain access to your important documents, the
ability to upload photos, and much more! This improved platform is designed to make your registration
experience smooth and efficient.
Smoke Detectors and Carbon Monoxide Detectors are Requiredl
Owners: I have ensured the batteries are changed, have tested ALL Smoke Detectors/Carbon
Monoxide Detectors and verified that they are less than 1O years old. P/ease initial 4\
Contact lhe Euilding Department regarding questions on type and location prior to purchasing
htlosr//www.varmoulh ma us/Documentc terNieMl 1221 /Smoke-deteclor-locatron
A non-refundabte apptication fee of $80 pef UniUfgntal is required
Rental Certificates expire on December 31"r, 2024.
lf NOT registering online, please make checks payable to: Town of Yarmouth and mail completed application &
payment to: Town of Yarmouth Health Department.
The Health Depaftment willcallto schedule an inspection if re uired. upon receipt of your application and fee
Rental Property Address
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<-Lrq onal Short Term (less than 31 days)Annual /s.u"
Rental Period
Trash Remoial by:
o*nq/ Tenant HousellDuptex Condo!_ Apartment_ Room
Rental of
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Mailing Address
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(requrred)Plmary Phone No.Alternate Phone No (requ red)E,mail Address
Owner's ReDreaentetrte/Re,ntaT
Aqent/Aqenbv Primary Phone No (required)E mail Address:
I have read and I arr fam,rrar wtth the Town of Yarmouth Chaotea
Yarmouth Short Term Rental Bylaw (rf applrcable) and lhe Ii4A.
for Human Habilation) all of which are available on our websrte
Furthermole, I understand I must notify the Health Department in writing when I am no longer renting the property, or I may besubject to fines and bes.
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108
Stathtt
Date /O-J),y,
Rental P roperty lnformation
All fields are re uired! lncom lete forms without a valid hone # or email cannot be rocessed
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Revised: 10/23/2023
Property Owner Name:
inimum
DAVENPORT DEWITT TR
20 N MAIN ST
SOUTH YARMOUTH, MA 02664