1 HARBOR STREET - HOUSING COMPLAINT [+ Cc,,) JL)aM
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CITY OF SALEM, MASSACHUSETTS
y, BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHII`GTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS!REHS,CHO,CP-FS LRAMDINQSALEM.COM
IiEALTH AGENT
COMPLAINT INTAKE FORM
Date: `� �� *" �;� � t` Time: 2—� S s , Received By: S
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Complaint Number: 1765 2�z
Complainant r
Address: Phone: 7'9�` !
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Property Owner/Occupant Name I Telephone #:
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