HomeMy WebLinkAboutNot Renting Affidavit 08_03_2025TOWN OF YARMOUTH Board of
Health
I I46 ROUTE 28. SOUTH YARMOUTH. MASSACHUSETTSO2664.2445I Health
DivisionTelephone (508) 398-2231, ext. l24l
Fax (508) 760-3472
AFFIDAVIT
Residential Property Not Offered for Rent
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C)wner's Name:An,l O"Frvert?d.Address
City/State/ZIP
Phone/Email:
Address
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Yarmouth Property Addrcss
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C&o 0'9,,ut.--, am the owner ofthe above-referencedp."pffiffu".inJUyf"-f*n of Yarmouth Tax Records. I hereby confirm that the
dwelling/unit/apartment mentioned above is not cunently rented or is being offered for
rent.
I am fully aware that according to the regulations of the Yarmouth Hcalth Department,
any residential property that is offered for rent or lease must be registered, and a Rental
Occupancy Certificate must be issued.
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 [or rent in thc future.
Owner(s) Signa
Please retum this affidavit to the Yarmouth Health Department at the following address
Yarmouth Health Department I 146 Route 28 South Yarmouth, MA.02664
Or email: sprovos@yarmouth.ma.us
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AUo q a ?ozs
Ciry/State/ZIP:
Therefore, I understand that if I decide to offer my residential property for rent in the
future, I must adhere to the following steps:
o Register with the Yarmouth Health Department.o Obtain a Rental Occupancy Certificate in accordance with Chapter 108 ofthe
Occupancy ofBuildings regulations. A rental inspection may be required.