Constituent Intake Form
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 and services, and assist them with navigating their state government.

We ask that you please fill out this form completely so that we may assist you with your request as soon as possible.
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Pursuant to the Privacy Act of 1974, our office cannot assist individuals without their express written 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. (Please type your full name below to sign and agree) *
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