29 PALMER STREET - ILLEGAL TATTOOING COMPLAINT a
CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEI..(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCO)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By-
Complaint Number: 2186
Complainant �—
Address: 4 fi-7 I » Phone: 44
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Investigated By: Date:
Property Owner/Occupant Name_ _ Telephone#: _