lien City of Waltham 610

							City of Waltham 610 Main Street Waltham, MA 02452

Date Received:_________________________

Municipal Lien Request
Date of Request____________________________

Requested by:__________________________________________
(name)

___________________________________________
(address)

___________________________________________
(city) (state) (zip)

Property location:________________________________________ Parcel/key #:____________________________________________

Payment enclosed: ____$25.00

____$100.00 ____$150.00

Send to:

City of Waltham Treasurer’s Office 610 Main Street Waltham, MA 02452