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Tax Form 4 UTN. ,, 4 TOWN OF DARTMOUTH a 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 ( 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