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 _________ oclock. 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 American LegalNet, Inc. www.USCourtForms.com