10 BECKET STREET - HOUSING COMPLAINT f
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CITY OF SALEM,MASSACHUSETTS
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KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCa SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2065
Complainant _
Address: Phone:
Investigated By: Date: _
Property Owner/Occupant Name Telephone#: