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7.Existing Lot,
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1 .Please tit tide of plans and docurnents you will be attaching to this applicaono
Elm Street& I Elm Court North Andover MA 0184
Civil
Documents:,Site and w r ►na ($is. Me rands
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PLAWNG a°illllllllu,
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Cerfification of P et of Mun. t
ICIP l Taxes, ees, Assessment �
Betterments and Other Municipal
The TOM of forth Andover General Bylaw
or license � Ater 1,��8�.'�.p►narA�'ee# n a l �,
c ense MS be+denied,eu"nde�d or revoked. f
Wud to any� ed 'the 'der thereof`has faced or
. this
��� �e�e�� �efte.rente or ether�rn+ui�' � '
sr�ing thr �rpp1�flor�,the � �:at �� ,. � �c�re+r� y
� "� pr een#e or she , paid all such taxes
. o4 s 4 rA fees.
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best of rn no +ter'*under the penalties of p qu that to ft
knowledge end beffef,. ! have not neghxied or
fees,aw timer a refused t any munici t xee,
n or�r�y der municipal or i�cIud� amounts under the PrOvIs.Ions f ecd ws -one assessed
re or a not applying r.e E1cen or
to any� t � ,r,even orother utter�� �� permit �
which � event � _ +�sub of such license or pe��end
or
meta Is card out or exereed
or about real estate whose � neglected,
- or Is to �d out or�eeeed on
r has o ,l ected,or refi ed to pay an local
aUeS$ ents. betterments or any other mural11W �' fie,���
del ohe�e.
Sighed under oath:
IIIIOIIIIIIV YII`F
°�mulll III' w "W' �lllllllll "
�� R�luulip1°�
r IN 101�i;
44
Addres
Does the PrOPertY Owner own an •
y add t onel property in North Andover 'des or Nor
if yes, please list th+Y,I Property address of any additional onal thy.
PropertyAddress: r
North Andover Tax CoDector Signature
77
Date
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