Under the Massachusetts Wetlands Protection Act
(to be submitted to the Massachusetts Department of Environmental Protection and the Conservation Commission when filing a Notice of Intent)
I, ___________________________________________________, hereby certify under the pains and penalties of perjury than on ____________________________________,
I gave notification to abutters in compliance with the second paragraph of Massachusetts General Laws Chapter 131, Section 40, and the D.E.P. Guide to Abutter Notification dated April 8, 1994 in connection with the following matter:
A Notice of Intent filed under the Massachusetts Wetlands Protection Act by
____________________________________ with the Newbury Conservation
Commission on _______________________ pertaining to property located at
The notification and the names and addresses of the abutters to whom it was given are attached to this Affidavit of Service.