TOWN OF MATTAPOISETT
16 Main Street, P.O. Box 433
Mattapoisett, MA 02739
NON-RESIDENTS
SHELLFISH PERMIT
MAIL ORDER FORM
DATE:
NAME: TELEPHONE (HM.)
Print
(WK.)
RESIDENTIAL ADDRESS: MAILING ADDRESS (if different)
Print Print
· PROOF OF RESIDENCY OR PROPERTY OWNERSHIP
(copy required – see mailing instructions below)
Check one:
? Tax Bill
? Utility Bill
? License
? Other
FEES:
MARION & ROCHESTER RESIDENTS $ 25.00
ALL OTHERS $125.00
CHECK ENCLOSED FOR: $
MAILING INSTRUCTIONS
ENCLOSE:
1. Self-Addressed Stamped Business Size Envelope ( $.58)
2. Completed Form
3. Check or Money Order made out to “Town of Mattapoisett”
MAIL TO:
Town of Mattapoisett
P. O. Box 433
Mattapoisett, MA 02739
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