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tax formoulx y. 1.!'TOWN OF DARTMOUTH Office of the Zoning Board of Appeals 400 Slocum Road,Town Office Building,Dartmouth, MA 02747 Telephone:508-910-1868 Board Members Michael Medeiros Esq., Chairman Halim Choubah P.E., Clerk Robert Gardner,Jr., Member Town Collector Town of Dartmouth Dartmouth, MA 02747 Name/Property Owner: Geoffrey DiSIauro Subject Project Address: 12 Bayview Avenue Map: 105 Lot: 52 The above referenced individual(s) is applying for a Special Permit and or Variance with the Zoning Board of Appeals. Pleasse certify that the above referenced individuals(s): is not ondelinquenttax, levy or fee owed to the Town of Dartmouth.q any is delinquent on tax, levy or fee owed to the Town of Dartmouth and has made arrangement fo ayment. Siuned Cida Date q\la\'21 own Collector