4 FIRST STREET - HOUSING COMPLAINT ;an n CITY OF SALEM, MASSACHUSETTS
r BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR (978)741-1800 FAX
FAx(978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CA-FS LRAMDIN(a SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2259
Complainant
Address: Phone:
Investigated By: _ Date:
Property Owner/Occupant Name Telephone#: