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Transfer Station Permits Newbury MA

VIEWS: 11 PAGES: 1

									                                               Town of Newbury Permit And License Application

                                                            This form may be used to purchase by mail:
                                                                 *Transfer Station Permit(s)
                                                                 *Parking Permit(s)
                                                                 *Dog Licenses (Copy of current rabies certificate is required)

                               Please complete all sections pertaining to the license(s) or permit(s) you would like to
                               purchase. Print form and enclose a check for the total amount made out to: Town of Newbury
                               and mail along with a self-addressed stamped envelope (REQUIRED) to:
                                                                          Newbury Town Hall
                                                               Attn: Clerk's Office
                                                               25 High Road
                                                                          Newbury MA 01951
                                                                    (MULTIPLE FORMS MAY BE USED IF NEEDED)

Your Name:
                                                                                                           Mailing Address (if different):
Your Address:                                                                   Address:
Newbury only, No PO #s


Town:                                                                                Town:

Phone No:                                       Email:



Transfer Station Permits:                                                                                                                       $0.00
                                                                                                             Transfer Station Total:
               First Sticker                                 2nd Household Sticker
               65+ yoa?


          Make of vehicle 1:                   Year of vehicle 1:              Reg No of vehicle 1:


          Make of vehicle 2:                   Year of vehicle 2:              Reg No of vehicle 2:

Parking Permits:                  Each vehicle:          $20.00                                                                                 $0.00
                                                                                                               Parking Permit Total:
  Number of vehicles:

          Make of vehicle 1:                   Year of vehicle 1:              Reg No of vehicle 1:


          Make of vehicle 2:                   Year of vehicle 2:              Reg No of vehicle 2:


Dog Licenses(included              copy of rabies cert.)       :       Each dog: $10.00                                                         $0.00
                                                                                                                      Dog License Total:
 Number of dogs:

    Dog #1:       Name :             Breed :                      Age :      Type:                Rabies Exp. Date:                    Vet:

    Dog #2:       Name :             Breed :                      Age :      Type:                Rabies Exp. Date:                    Vet:

    Dog #3:       Name :             Breed :                   Age :         Type:                Rabies Exp. Date:                    Vet:

    Dog #4:       Name :             Breed :                      Age :      Type:                Rabies Exp. Date:                    Vet:




      Print Form                                                                       Please pay this amount > :                             $0.00

								
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