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pf,YAR Application for 2024 Rental Regist tion--
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TOWN OF YARMOUTH
Health Department
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664
Telephone (508) 398-2231, ext. 1240
Fax (508) 760-3472
E-mail: epolitegyarmouth.ma.us
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The Town of Yarmouth is excited to announce that we've streamlined the online registration process to
make it more user-friendly than ever before! Simply visit https:l/varmouthma.partal,opengov.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 Required!
Owners: I have ensured the batteries are changed, have tested ALL Smoke Detect° !Carbon
Monoxide Detectors and verified that they are less than 10 years old: Please initial
Contact the Building Department regarding questions on type and location prior to purcha g �
httos://www.varrnouth.ma.us/DocumentCenterNiew/11221/Smoke-detector-location
• Anon-refundable application fee of$80 per unit/rental is required.X Coa CA110s ;7 t7 5: .R0
• Rental Certificates expire on December 3151, 2024.
• If NOT registering online, please make checks payable to: Town of Yarmouth and mail completed application&
payment to: Town of Yarmouth Health Department.
• The Health Department will call to schedule an inspection if required, upon receipt of your application and fee.
Rental Property Information
All fields are required!Incomplete forms without a valid phone#or email cannot be processed.
Rental Property Address:Yctre,v,a}n Gory,r10,'1 5 Rental Period:
(6 1 (0 /2 ` eut yG'rMOt-kih i-G"a (,)ra� `1Annual'�Seasonal_Short Term (less than 31 days) _
Trash Removal by: Rental of: (pC% Apc rimP-4 -k.
Owner Tenant House Duplex_Condo Apartment��Room�
Property Owner Name: Mailing Address:
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(required)Primary Phone No. I Alternate Phone No. (required)E-mail Address:
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Owner's Representative/Rental Primary Phone No (required)E-mail Address:
Agent/Agency
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I have read and lam familiar with the Town of Yarmouth Chapter 108 Rental Housing Bylaw, Chapter 104 Anti-Noise Bylaw, Town of
Yarmouth Short Term Rental Bylaw(if applicable)and the MA. State Sanitary Code, Chapter II (Minimum Standards of Fitness
for Human Habitation)all of which are available on our website.https://www.yarmouth.ma.us/423/RentalHousinq-Program
Furthermore,I understand I must notify the Health Department in writing when I am no longer renting the property,or I may be
subject to fnes and fees.
Sign: CaL,VV-L Date: 3 ate. a
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Revised:10/23/2023