HomeMy WebLinkAboutLegal Notice Charge Authorization Form (word)
LEGAL NOTICE CHARGE AUTHORIZATION
DATE: _______________
TO: GateHouse Media New England/Community Newspaper Company
LEGAL NOTICE DEPARTMENT
I hereby authorize GateHouse Media New England/Community Newspaper Company to bill me directly for the legal notice published in the Lexington Minuteman on X
for a public meeting with the Lexington Conservation Commission on _ X _ for property at ______________________________.
SIGNATURE: ______________________________________
Please print where to send bill:
Name: ___________________________________________
Business or Organization, if any: _____________________________
Street Address: ______________________________________
City/Town: ________________________________________
State: _________________ Zip Code: ______________________
Day-time Telephone Number: ___________________________