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DOMINICK PANGALLO MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 98 WASHINGTON STREET, 3RD FLOOR SALEM, MA 01970 TEL. (978) 741-1800 [EMAIL REDACTED] DAVID GREENBAUM, RS, CHO HEALTH AGENT 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 authorized agents from any loss or injury sustained of whatever nature and description occasioned by my/our absence during said inspection. Tenant/Lessee Owner/Lessor Address Address Address of unit to be inspected Date