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Town of Mashpee 16 Great.Neck Road North <br /> Mashpee, MA 02649 <br /> PLEASE SUBMIT FORM WITH ZBA PETITION AFTER OBTAINING TAX COLLECTOR <br /> AND 911 COORDINATOR SIGNATURES <br /> Date: <br /> Property address: .. ................—-—------ <br /> Assessor's Map# Parcel#-. ....... <br /> 7 <br /> VA <br /> I have reviewed the address. _. Z .... .. <br /> rd'�E9=1I--VCo�oZrd!�in�at.'or Signa'ture Date <br /> I hereby attest that .............. <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, <br /> in arrears of payment of any local taxes as may be applicable under Section I of Chapter 112 of the <br /> Mashpee Code. <br /> .......... ...... <br /> Treasurer/Collect Date <br /> Treasure <br />