2024 Not Rentaing Affidavit OWNift
OF YARMOUTH
" '`. Board of
f lea lth
t _ )zj 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-244_` Health
EESE
" a� Telephone (508) 398-2231, ext. 1240 Division
. '` Fax (508) 760-3472
AFFIDAVIT
Residential Property Not Offered for Rent
Date: lu
31) 2J2 �
,Ip
Owner's Name:D\ Jv . T2A 6(N j-Du ` -S M.1
Address: 5 !RA 1 k_izo pk'o >J-
City/State/ZIP:_/Naiyia.}nAp a 2T— ; {s\ O L ,'1
Phone/Email: d.b Cc t 1 v1 ✓15��n(� viitac.. , CatA
Yarmouth Property Address:
Address: 5- RA \L P.--e) -'-J'li
City/State/ZIP: 7 -p eQ,2-, 0 7 S�
I ' 0V"t(7 r L L. 4 the owner of the above-referenced property, as
v ied by then of Yarmouth Tax Records. I hereby confirm that the
dwelling/unit/apartment mentioned above is not currently rented or is being offered for
rent.
I am fully aware that according to the regulations of the Yarmouth Health Department,
any residential property that is offered for rent or lease must be registered, and a Rental
Occupancy Certificate must be issued.
Therefore, I understand that if I decide to offer my residential property for rent in the
future, I must adhere to the following steps:
• Register with the Yarmouth Health Department.
• Obtain a Rental Occupancy Certificate in accordance with Chapter 108 of the
Occupancy of Buildings regulations. A rental inspection may be required.
By signing below, I acknowledge my understanding of these requirements and commit to
complying with them when and if I choose to offer my property for rent in the future.
Owner(s) Signature: __ W___________
Please return this affidavit to the Yarmouth Health Department at the following address:
Yarmouth Health Department 1146 Route 28 South Yarmouth, MA. 02664
Or email: epolite@yarmouth.ma.us RECEIVED
MAR 1 2 2024
HEALTH DEPT.