To: Town ClerkPursuant to regulation 333 CMR 13:03 adopted by the Massachusetts PesticideBoard, I hereby register the property listed below for exclusion from pesticide applications this year. Name * Address * City * Zip * Phone * I request exclusion from the following pesticide application programs * The boundaries of the property to be excluded will be marked every 50 feet by orange surveyor's tape or other appropriate means * Example: Explain how your property will be visible to prevent application of pesticide. Leave this field blank