33 UPHAM STREET - HOUSING COMPLAINT nh J,
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4Tx FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN`SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: f Time: Received By-.
Complaint Number: 2305
Complainant
Address: Phone:
Investigated By: J Date:
Property Owner/Occupant Name Telephone #: