8 CHERRY STREET, #1R SIGNED TENANT RELEASE FORM FOR COF 11/28/22,8:31 AM about:blank
City of Salem, Massachusetts
Board of Health IV
f = 98 Washington St.3rd Floor Salem.MA 01970
Tel.(978)741-1800
health@salem.com PubliCHea ith
Pr-t.Promote.Protect.
Release
In accordance with Massachusetts General Laws Chapter 111;Code of Massachusetts Regulations 410.000 et.Seq. ;State Sanitary Code Chapter II
and Article XIII of the City of Salem Ordinance, undersigned owner/lessor and tenant/lessee of a unit of residential property, hereby authorize the
Salem Board of Health or its authorized agents to inspect the residence identified below in accordance with the aforementioned statutes,regulations
and ordinances.
In the event it is necessary that said inspection be done in my/our absence, I/we expressly authorized the same and for my/our successors and
assigns hereby release and discharge the City of Salem,Salem Board of Health and its aythorizet.!agents from any loss or injury sustained of
whatever nature and description occasioned by my/our absence during said inspection. /
i
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Te essee Ow r/Lessor
Address Add r6ss if
8 CHERRY STREET
SALEM MA 01970
Address of unit to be inspected
Date
1
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