10 PORTER STREET - HOUSING COMPLAINT Q41\
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TiL.(978)741-1800
FAx(978)745-0343
LARRY RAMDTN,RS/REHS,CHO,CP-FS LRAMDIN NSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: f1 /21 /Z!7 Time: Received By: IF
Complaint Number: 1787
Complainant
Address:
Phone:
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Investigated By: Date:
Property Owner/Occupant Name Telephone #:
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