90 Mason Street Salem News Form 4THE SALEM TO
REQUEST FOR LEGAL NOTICE
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***Im ortant:Average legal notice costs are estimated;customers paying by check will be refunded if the
legal ad is less than the deposit amount.
If paying by check, please make checks payable to THE SALEM NEWS and mail to:
City of Salem
Dept.Of Planning and Community Development
Co:ZBA
98 Washington St
2nd Floor
Salem, MA 01970
Please choose and check one of the boxes for payment option:
El Check# (attach check)
redit Card—Must call Salem News legal notice clerk at 978-675-2710
If payment is not received,the legal notice may be cancelled.
I understand that by signing this form, I am agreeing to the cost of the legal notice to be published in the
newspaper.
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Signed Applicant/Authorized Age t
Print Name: l�/4q 1",4
Address: '"7 :5 S
Email: b1114 A
Phone: ' ,
Date: if -