HomeMy WebLinkAboutNot Renting Affidavit 08_05_2025to
A{
TOWN OF'YARMOUTH Board of
Hsalth
I I46 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTSO?664-24451 Health
DivisionTelephone (508) 398-2231, ext. l24l
Fax (508) 760-3472 ,,: iGtr0trE._,
LUG 1 1 2025
HEALI? DEPT.
Date J)
e elroosltr
AFFIDAVIT
Residential Properfy Not Offered for Ren
)
Owner's Name
Address:
City/State/ZIP
Phonc/Email:
,J ole,c or4
Yarmouth Propcrty Address
Address:5s 'R)
City/State/ZlP
(e-\ro^t , am the orvner ol the above-referenced
, as verified by the Town o 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 ofl'ered for rent or lease must be registered, and a Rental
Occupancy Certificate must be issued.
Thcrefore, I understand that if I decide to offer my residential propcrty for rcnt in the
luture. I must adhere to the lollowing steps:
o Register with the Yannouth Health Department.
o Obtain a Rqqtal Occupancy Ce4ificate in accordance with Chqrter 108 of the
Occupancy of Buildings regulations. A rental inspection ntay 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 property for rent,in the future
Owner(s) Srgnature
Please retum this affidavit to the Yarmouth Health Department at the following address
Yarmouth Health Department 1146 Route 28 South Yarmouth, MA. 02664
Or email: sprovos@yarmouth.ma.us
vl
5 en0
I.
I
I