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Tawn afMaslipee <br /> N � <br /> 16 GreatJVeck-Pvbad,Jd rth <br /> Maslipee,Alassachuseas 02649 <br /> sT�uTEio'`n*r <br /> PLEASE SUBMIT FORM WITH ZBA PETITION AFTER OBTAINING TAX COLLECTOR <br /> AND 911 COORDINATOR SIGNATURES <br /> Date: _ <br /> Property address: i <br /> c <br /> Assessor's Map# Parcel# 1! <br /> reviewed the address. <br /> I have rev � <br /> GI nd E911 Coordinator Signature Date <br /> I hereby attest that ZZ 46Z!�Z f <br /> OWNER OF RECORD <br /> is (are) the owner(s) of the above-referenced property. <br /> I hereby further attest that the owner of the above-cited property is not, to the best of my knowledge, in <br /> arrears of payment of any local taxes as maybe applicable under Section I of Chapter 112 of the Mashpee <br /> Code. <br /> Tr sur `f ollector Date <br /> Rev. 3103115 <br />