11 Victory Road Complaint 4-29-2019 CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDBQ a SALEM_COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2422
Complainant 24�q 71Z9
Address: Phone:
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Investigated By: Date:
Property Owner/Occupant Name Telephone#: