30 LORING AVENUE - HOUSING COMPLAINT a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,47"FLOOR
{ MAYOR TEL.(978)741-1800
1 FAx(978)745-0343
i
LARRY RAMDIN,RS%REHS,CHO,CP-FS LRAMDINrSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
9
Date: P Time: S , r Received By: ,
Complaint Number: 1759
Complainant Ale,-) 1 y
Address: L. v. Phone:
IP Cl `I
Investigated By: Date:
Property Owner/Occupant Name Telephone #: