20 PARK STREET - HOUSING COMPLAINT }� 1
CITY OF SALEM, MASSACHUSETTS
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BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,41H FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAmDrNQsALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2406 _
Complainant
Address: Phone:
Investigated By: —Date: i _ ,
Property Owner/Occupant Name _ Telephone #: -
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