5 GRANT ROAD - HOUSING COMPLAINT ;; . CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON,STREET,4T'FLOOR
MAYOR TEI..(978)741-1800
FAX(978)745-0343
LARRY RAMDI-N,RSIREHS,CHO,CP-FS LRAMDIN'('SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 1786
Complainant '
Address: / - Phone:
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Investigated By: Date:
Property Owner/Occupant Name Telephone #: