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Town of Mashpee <br /> Zoning Board of Appeals <br /> PLEASE SUBMIT FORM WITH ZBA PETITION AFTER OBTAINING TAX <br /> COLLECTOR AND 911 COORDINATOR SIGNATURES <br /> Date: 9. �2C / <br /> Property address <br /> Assessor's Map# Parcel# <br /> I have reviewed the address.,/- - � ' <br /> Clay Nicholson Date <br /> GIS and E911 Coordinator f <br /> ;r:��;::�1:�;F�:;r;�kk�r:ex�C;k�:k�;:�:k��;:���;�•k:c•kxrx;F:e;�ysF:�:k:':;��:k�;k�•!:*:e���c�:�c���e�:�;�k�;A k��;t*�:l•�' <br /> I hereby attest that,. <br /> OWNER OF RECORD <br /> is (are) the owner(s) of the above-referenced property. <br /> I hereby ftuther attest that the owner of the above-cited property is not,to the best of my <br /> knowledge,in arrears of payment of any local taxes as may be applicable under Section 1,of <br /> Chapter 112 of the Mashpee Code. <br /> Treast i er olle for Date <br /> �_.Ate. <br /> REVISED OCTOBER 2012 MASHPEE TOWN CLERK <br /> AUG 2 6 2013 <br /> RECEIVED BY <br />