2 Mount Vernon Street Complaint 5-16-2019 ovmra�
{yn, CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(4 SALEM COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By: `
Complaint Number: 2444
Complainant 1
Address: �J Phone: 3-
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Vault
Investigated By: Date:
Property Owner/Occupant Name Telephone #: