32 WILLSON STREET - HOUSING COMPLAINT CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,Ore FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRANIDINr'.SALEM.00�1
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: �� IZo�'� Time: f �{0 .,� Received By:
Complaint Number: 1762
Complainant
Address: Phone:kv- -
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Investigated By: Date:
Property Owner/Occupant Name Telephone#: