35 MARLBOROUGH ROAD - OVERGROWTH & RAT COMPLAINT CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"'FLOOR
MAYOR (978)741-10
FAx
FAx(978)745-034343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(c)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: _ Received By:
Complaint Number: 2176
Complainant _-
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name _ Telephone#: