4 UNION STREET - HOUSING COMPLAINT CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR (978)741-1800 FAX
FAx(978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN[a SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By: _
Complaint Number: 2038
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name_ Telephone #: