41 FEDERAL STREET - HOUSING COMPLAINT CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON-STREET,4-"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDN,RS,REHS,CHO,CP-FS LRAMD1N(&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Received By: .)ar-Ge-v
Date:' Time: 191,1
Complaint Number: 1766
Complainant 1-1v-v ,►fi c� n Do vp
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Address: Jeral Lree- Phone: 603-29
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Investigated By: Date:
Property Owner/Occupant Name Telephone #: