15 RAYMOND ROAD - HOUSING COMPLAINT n
ICITY OF SALEM,MASSACHUSETTS
OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,eH FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN0,1SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: -1 Time: Received By:
Complaint Number: 2331
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Complainant
Address: Phone:
Investigated By: _ _ Date: l
Property Owner/Occupant Name ���� { u-' k. "felephorie #47) 116( OP �16 J9
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