3 ROPES STREET - HOUSING COMPLAINT _� CITY OF SALEM,MASSACHUSETTS
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3 "—' BOARD OF HEALTH
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KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(n:SALEM.COM
11EALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2230
Complainant
Address: i f' 1 Phone:
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Investigated By:, C) Date: f�
Telephone #:
Property Owner/Occupant Name