31 Salem Street - Violations APPLICATION s ADULT NUMBER 4Trial Court of Massachusetts
FOR COMPLAINT 0 JUVENILE _ - 1 District Court Department
❑ ARREST HEARING ❑ S MM;kVS ❑ WARRANT COURT DIVISION
The within named complainant requests that a complaint issue against the within
nafned defendant, charging said defendant with the offense(s)listed below.
DAT OF PPLIGATIGN DAT OF O ENSE PLACE OF OFFENS
NAME OF COMPLAINARI
f NO. OFFENSE G.L. Ch. and Se
ADDREA AND ZIP CODE OF COMPLAINANT A!. /. .. .
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NAME,ADDRESS AND ZIP CODE OF DUENDANT
3.
COURT USE A hearing upon this complaint application DATEOFHEARING": ' TIME 9FH -jR1NG •O "' T USE
AT
ONLY—� will be held at the above court address on #fir ' ; , : ONLY
CASE PARTICULARS — BE SPECIFIC
NAME OF VICTIM DESCRIPTION OF PROPERTY VALUE OR PROPERTY TYPE OF CCIINTAOLLED
NO. Owner of property, Goods stolen,what Over or under SUBSTANCE VWEAPON
person assaulted,etc. destroyed,etc. $250. Marijuana,gun,etc.
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OTHER REMARKS:
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SIGNATORE OF COMPLAINANT t.
D •FENQANT IDENTIFICATION INFORMATION = Complete data below if known.
DATE OF BIRTH PCAcE OF EH SOCIALSECURITYNUMBER SEX RACE HEIGHT I WEIGHT I EYES HAIR
OCCUPATION EMPLOYERISCHOOL MOTHER'S NAME(MAIDEN) FATHER'S NAME
DC•CR2(3/88)
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TICKET NO: A2373 DATE ISSUED: 01-27-99 DATE DUE: 02-17-99 GRACE PERIOD: 02-27-99
LAST NAME: KLOTZ FIRST NAME: TIMOTHY MI :
STREET NO. : SUF: STREET NAME : P.O. BOX 1341 APT. NO. :
CITY: MARBLEHEAD, STATE: MA ZIP: 01945 SS : D. O.B. :
EMPLOYEE NO. : 3525 EMPLOYEE NAME: JOSE L. DIAZ
DEPARTMENT ISSUING TICKET: HEALTH VIOLATION SECTION: REG. 7
OFFENSE: TRASH - RESPONSIBILITY OF OWNER
DATE OF VIOLATION: 01-26-99
LOCATION OF VIOLATION: 31 SALEM STREET NO: 31 STREET: SALEM ST APT:
FINE DUE $25 . 00 LATE PAID: 03-09-99 CASH: CHECK: 1065
FIRST OFFENSE: SECOND OFFENSE: SUBSEQUENT OFFENSE :
HEARING REQUESTED BY VIOLATOR:
DISPOSITION BY DEPT:
DISTRICT COURT RECORD
DATE OF HEARING: TIME OF HEARING:
DISPOSITION:
DATE DUE : DATE PAID:
COMMENTS :