OFFICE OF

PLANNING BOARD

Town Of Belchertown

P.O. Box 964

Belchertown, Massachusetts 01007

TO: The Sentinel

FROM: Planning Board - Belchertown, MA

RE: Public Hearing Notice Form

DATE:

This memo is to request that a public hearing notice be placed in your newspaper for (i.e., zone change request, subdivision plans, etc.):

The project applicants agree to pay for this publication as part of their request, and submit an authorized signature and address for this purpose:

Signature: ______________________________________

Address: ______________________________________

______________________________________

Telephone no.: ______________________________________

If there are questions regarding this request, please call the Planning Board

office at 413-323-0407. Thank you.

copy: Planning Board

Applicant

File