REQUEST FOR CRIMINAL COMPLAINT
FOR FIRE CODE VIOLATIONS

To any Justice of Clerk-Magistrate of the                 Housing
Court:
_________________________________________________________________
on behalf of the Commonwealth, on oath complains that:

_________________________________________________________________
was and is the owner of residential premises located at 

________________________________________________________________;

On ____________________________, 200___, a representative of the 
____________________________________________________Program
inspected the said premises and determined that the dwelling did
not comply with the Fire Prevention Law, Gen.L.c. 148, §     , and
Rule ________________of the Board of Fire Prevention Regulations
under Gen.L. c. 148, §_______, governing_______________________;

On _____________________________, 200___, pursuant to §___________
of  the  Rules,  the  defendant  was  served  with  a  written  order  to
comply;

On  _____________________________,  200___,  and  from  day  to  day
thereafter the defendant has failed to comply with the order, each
such day being a separate offense and a separate and distinct count
of this Complaint;

all in violation of Rule ___________ and Gen.L. c. 148, §________,
and the defendant did so willfully, intentionally, recklessly or
repeatedly.

__________________________
Date:

______________________________
Complainant:

Assigned for hearing on _____________________,200__, at _________
o’clock.

On hearing (Complainant)(Defendant)(both parties)(neither party),
I  find  no  probable  cause  for  the  Complaint.    Process  shall  not
issue. 

On hearing (Complainant)(Defendant)(both parties)(neither party),
and Complainant having sworn or affirmed that the Complaint is true
upon  information  and  belief,  I  find  probable  cause,  and  order
summons to issue returnable _______________________________.

______________________
Date:

___________________________________
Clerk-Magistrate