2-4 Howard Street Rooming House Inspection CITY OF SALEM,MASSACHUSETTS )y
LICENSING BOARD
120 Washington Street ell
Salem,MA 01970
978-745-9595 ext. 421
Chairman,Harold F.Blake,Jr.
Stanley J.Usovicz,Jr. John H.Casey
Mayor Denise L.Flynn
Judy Davenport,Clerk
RELEASE
IN ACCORDANCE WITH MASSACHUSETTS GENERAL LAWS, CHAPTER 140, SECTION 25,
INSPECTION OF PREMISES,UNDERSIGNED OWNER/LESSOR AND TENANT/LESSEE OF A UNIT
OF RESIDENTIAL PROPERTY, HEREBY AUTHORIZE THE SALEM LICENSING BOARD OR ITS
AUTHORIZED AGENTS TO INSPECT THE RESIDENCE IDENTIFIED BELOW, IN ACCORDANCE
WITH THE AFOREMENTIONED STATUES.
IN THE EVENT IT IS NECESSARY THAT SAID INSPECTION BE DONE IN MY/OUR ABSENCE, I/WE
EXPRESSLY AUTHORIZE THE SAME AND FOR MY/OUR SUCCESSORS AND ASSIGNS HEREBY
RELEASE AND DISCHARGE THE CITY OF SALEM, SALEM LICENSING BOARD AND ITS
AUTHORIZED AGENTS FROM ANY LOSS OR INJURY SUSTAINED OF WHATEVER NATURE AND
DESCRIPTION OCCAISIONED BY MY/OUR ABSENCE DURING SAID INSPECTION.
NAME OF LODGING HOUSE:
ADDRESS OF LODGING HOUSE:
UNIT#TO BE INSPECTED:
TENANT/LESSEE: .' x� OWNER/LESSOR:
SIGNATURE SIGNATURE
PRINT NAME PRINT NAME
ADDRESS: 4/ 4,1 r,-teo' ST _ ADDRESS:
release
CITY OF SALEM, MASSACHUSETTS l9y.,
LICENSING BOARD 1,
120 Washington Street 44-
Salem, MA 01970
978-745-9595 ext. 421
Chairman,Harold F.Blake,Jr.
Stanley J.Usovicz,Jr. John H.Casey
Mayor Denise L.Flynn
Judy Davenport,Clerk
RELEASE
IN ACCORDANCE WITH MASSACHUSETTS GENERAL LAWS, CHAPTER 140, SECTION 25,
INSPECTION OF PREMISES,UNDERSIGNED OWNER/LESSOR AND TENANT/LESSEE OF A UNIT
OF RESIDENTIAL PROPERTY,HEREBY AUTHORIZE THE SALEM LICENSING BOARD OR ITS
AUTHORIZED AGENTS TO INSPECT THE RESIDENCE IDENTIFIED BELOW, IN ACCORDANCE
WITH THE AFOREMENTIONED STATUES.
IN THE EVENT IT IS NECESSARY THAT SAID INSPECTION BE DONE IN MY/OUR ABSENCE,UWE
EXPRESSLY AUTHORIZE THE SAME AND FOR MY/OUR SUCCESSORS AND ASSIGNS HEREBY
RELEASE AND DISCHARGE THE CITY OF SALEM, SALEM LICENSING BOARD AND ITS
AUTHORIZED AGENTS FROM ANY LOSS OR INJURY SUSTAINED OF WHATEVER NATURE AND
DESCRIPTION OCCAISIONED BY MY/OUR ABSENCE DURING SAID INSPECTION.
NAME OF LODGING HOUSE:
ADDRESS OF LODGING HOUSE: _
UNIT#TO BE INSPECTED:
TENANT/LESSEE: OWNER/LESSOR:
SIGNATURE SIGNATURE
PRINT NAME PRINT NAME
ADDRESS: ADDRESS:
release
} CITY OF SALEM, MASSACHUSETTS
LICENSING BOARD
120 Washington Street
Salem, MA 01970
978-745-9595 ext. 421
Chairman,Harold F.Blake,Jr.
Stanley J.Usovicz,Jr. John H.Casey
Mayor Denise L.Flynn
Judy Davenport,Clerk
RELEASE
IN ACCORDANCE WITH MASSACHUSETTS GENERAL LAWS, CHAPTER 140, SECTION 25,
INSPECTION OF PREMISES,UNDERSIGNED OWNER/LESSOR AND TENANT/LESSEE OF A UNIT
OF RESIDENTIAL PROPERTY, HEREBY AUTHORIZE THE SALEM LICENSING BOARD OR ITS
AUTHORIZED AGENTS TO INSPECT THE RESIDENCE IDENTIFIED BELOW, IN ACCORDANCE
WITH THE AFOREMENTIONED STATUES.
IN THE EVENT IT IS NECESSARY THAT SAID INSPECTION BE DONE IN MY/OUR ABSENCE, I/WE
EXPRESSLY AUTHORIZE THE SAME AND FOR MY/OUR SUCCESSORS AND ASSIGNS HEREBY
RELEASE AND DISCHARGE THE CITY OF SALEM, SALEM LICENSING BOARD AND ITS
AUTHORIZED AGENTS FROM ANY LOSS OR INJURY SUSTAINED OF WHATEVER NATURE AND
DESCRIPTION OCCAISIONED BY MY/OUR ABSENCE DURING SAID INSPECTION.
NAME OF LODGING HOUSE:
ADDRESS OF LODGING HOUSE:
UNIT#TO BE INSPECTED:
TENANT/LESSEE: OWNBR/LESSOR:
SIGNATURE SIGNATURE
PRINT NAME PRINT NAME
ADDRESS: ADDRESS:
release
CITY OF SALEM,MASSACHUSETTS
LICENSING BOARD 031
120 Washington Street
Salem,MA 01970
978-745-9595 ext. 421
Chairman,Harold F.Blake,Jr.
Stanley J.Usovicz,Jr. John H.Casey
Mayor Denise L.Flynn
Judy Davenport,Clerk
RELEASE
IN ACCORDANCE WITH MASSACHUSETTS GENERAL LAWS, CHAPTER 140, SECTION 25,
INSPECTION OF PREMISES,UNDERSIGNED OWNER/LESSOR AND TENANT/LESSEE OF A UNIT
OF RESIDENTIAL PROPERTY, HEREBY AUTHORIZE THE SALEM LICENSING BOARD OR ITS
AUTHORIZED AGENTS TO INSPECT THE RESIDENCE IDENTIFIED BELOW, IN ACCORDANCE
WITH THE AFOREMENTIONED STATUES.
IN THE EVENT IT IS NECESSARY THAT SAID INSPECTION BE DONE IN MY/OUR ABSENCE, I/WE
EXPRESSLY AUTHORIZE THE SAME AND FOR MY/OUR SUCCESSORS AND ASSIGNS HEREBY
RELEASE AND DISCHARGE THE CITY OF SALEM, SALEM LICENSING BOARD AND ITS
AUTHORIZED AGENTS FROM ANY LOSS OR INJURY SUSTAINED OF WHATEVER NATURE AND
DESCRIPTION OCCAISIONED BY MY/OUR ABSENCE DURING SAID INSPECTION.
NAME OF LODGING HOUSE:
ADDRESS OF LODGING HOUSE:
UNIT#TO BE INSPECTED:
TENANT/LESSEE: y OWNER/LESSOR:
SIGNATURE SIGNATURE
PRINT NAME PRINT NAME
ADDRESS: ADDRESS:
ikWe r� See
release