491 Apt 2512 MRVP Report 1998 CITY OF NORTHAMPTON 1HAly_p
BOARD OF HEALTH �.�.,,,, �°ti
MEMBERS '`
MASSACHUSETTS 01060 ) A,('"a
JOHN T.JOYCE,Chairman a � *
ANNE BURES,M.D. . M►
CYNTHIA DOURMASHKIN,R.N. �- !�
PETER J. McERLAIN,Health Agent
OFFICE OF THE 210 MAIN STREET
(413)587-1214 BOARD OF HEALTH NORTHAMPTON,MA 01060
FAX(413)587-1264
)/) APPLICATION FOR HOUSING INSPECTION AND CERTIFICATION OF FITNESS FOR
MASSACHUSETTS RENTAL VOUCHER PROGRAM
Nam7of Property Owner: 16 Date: /O - • 7
Address of Property Owner: iiy/ '- :