38 FAIRMOUNT STREET - HOUSING COMPLAINT CITY OF SALEM, MASSACHUSETTS
a BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDLNPa SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2276
Complainant
Address: .7 Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: _ _