Constituent Intake Form Logo
Language
  • English (US)
  • Spanish (Latin America)
  • Constituent Intake Form

    *PLEASE READ THE FOLLOWING CAREFULLY*
  • Introduction

    Thank you for contacting the Office of State Representative Andy X. Vargas. We love hearing from our constituents! Our mission is to connect Haverhill residents to state resources, services and to assist them with navigating their state government. As such, this form is strictly for our constituents. All other submissions will automatically be deleted. Please DO NOT use this form to ask questions about legislation, policy or events. For those inquiries, please email Andy.Vargas@mahouse.gov. Please DO NOT submit this form more than once for the same issue - it will not speed up casework and may slow it down.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Pursuant to the Privacy Act of 1974, our office cannot assist individuals without their express consent. I,*   hereby authorize the Office of State Representative Andy X. Vargas to act on my behalf, and therefore, waive all rights in the release of any and all related information and records. I also understand that this inquiry may not conclude in my best interest. I sign this waiver in good conscience and without mental reservation.

  • Should be Empty: