36 PERKINS STREET - NUISANCE COMPLAINT CITY OF SALEM MASSACHUSETTS
h. BOARD OF HEALTH I
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAN4DIN,RS/REHS,CHO,CP-FS LRAMDfN(&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: r Time: f rM- Received By:
Complaint Number: 1794
Complainant
La
Address Phone: 9/7?
1-4
-:l
Investigated By: Date:
Property Oxvner/Occupant Name, Telephone #: