40 BUFFUM STREET - HOUSING COMPLAINT 4i CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.FAx(978)741- 0
FAx(978)745-Q34343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2250
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone#: