3 LUSSIER STREET - HOUSING COMPLAINT 1 `
1 ,
'!T a 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(a1SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
r�
Date: '----- Time: Received By:
Complaint Number: 225$
Complainant '
Address: Phone:
J
Investigated By: 1 1 Date: ( ?
Property Owner/Occupant Name _ Telephone #�
r
r� -VI A