Tax Form 4 UTN. ,,
4 TOWN OF DARTMOUTH
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3 Office of the Zoning Board of Appeals
3��.I664
Sys 400 Slocum Road, Town Office Building,Dartmouth, MA 02747
Telephone: 508-910-1868
Board Members
Halim Choubah, P.E., Chairman
Michael Medeiros Esq., Clerk
Robert Gardner,Jr., Member
Town Collector
Town of Dartmouth
Dartmouth, MA 02747
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Name/Property Owner gefircy f N?RR r an Lee4f
Subject Project Address 1 J2edLC0Cid %.5t
Map:_ /02Q Lot:
The above referenced individual(s) is applying for a Special Permit and or Variance with the
Zoning Board of Appeals.
Please certify that the above referenced individuals(s):as
is not delinquent on any tax, levy or fee owed to the Town of Dartmouth.
is delinquent on tax, levy or fee owed to the Town of Dartmouth and has made
arrangements for payment.
Signed C ::"'�`. �"' G ' / Date zr
Town Collector