13 BRYANT STREET - HOUSING COMPLAINT has, CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(cDSALEM.COM
HEALTH AGENT
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COMPLAINT INTAKE FORM
Date: Time: - Received By:
Complaint Number: 2.184
Complainant
Address: •. •
Phone:
01
Investigated By: _ '� Date:
Property Owner/Occupant Name 1�_ Telephone#: