31 PERKINS STREET - HOUSING COMPLAINT n[iIRT
CITY OF SALEM, MASSACHUSETTS
/ BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(aSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2008
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: