2A WILLOW AVENUE - HOUSING COMPLAINT a
CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KM4BERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2284
Complainant
Address: ' ' " Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone#:
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