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2198 Main Street
Brewster, MA 02631-1898
p (508) 896-3701 x1133
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brewplan@brewster-ma.gov
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AGENT AFFIDAVIT
Name of Owner: Phone:
Address (mailing):
Address of Property:
Current Map Lot Old Map Lot
I testify that I have granted the authority to: to act as agent for me and
the property for which IIWe own(s).
Agent Name: Phone:
Company Name:
Address:
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature of Owner
Date:
Revised 12-2016 Planning Board Agent Affidavit Page 1 of 1