HomeMy WebLinkAboutNOT RENTING AFFIDAVIT 2025t TOWN OF YARMOUTH Board of
Health
I I46 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETT302664-24451 Hcalth
Telephone (508) 398-2231, ext. 1241
Fax (508) 760-3472
AFFIDAVIT
Residential Property Not Offered for Rent
vlsron
Date: I 2,
Paol +b at^a Lebra,s
e +
vn6 c)13
st-rb ra-z{ (€ t 6 Ve-riza h.nPI
lt
Owner's Name
Address:
City/State/ZIP
Ptrone/Email:qUt 29{-t{?7s
Addrcss:
Yarmouth Property Addrcss
t t R.>s. tFr- E1 ,
I,
Ciry/Srate/ZIP W. Vav r4^ol.(t\,\, t-tA 'o zb'73
P^J +&*br"o- GE YZl-9 , am the owner ofthe above-referenced
property, as verified by the Town of Yarmouth Tax Records. I hereby confirm that the
dwelling/unit/apartment mentioned above is not currently rented or is being ofl'ered for
rent.
I am fully aware that according to the regulations of the Yarmouth Health Dcpartment,
any residential property that is offered for rent or lease must be registered, and a Rental
Occupancy Certificate must be issued.
Thereforc, I understand that if I decide to offer my residential property for rcnt in the
luture. I must adhere to the following steps:. Register with the Yarmouth Health Department.o Obtain a Rental Occupancy Certificate in accordance with Chapter 108 ofthe
Occupancy of Buildings regulations. A rental inspection mat be required.
By signing below, I acknowledge my understanding of these requirements and commit to
complying with them when and if I c ose er my property for rent in the future
Owner(s) Signature
L4'T1,,
Please retum this affidavit to the Yarmouth Health Department at the following address
Yamrouth Health Deparrment I 146 Route 28 South yarmouth. MA.02664
Or email: sprovos@yarmouth.ma.us
,tt6
/s
taa
-A-*"-""-