41 NICHOLS STREET - HOUSING COMPLAINT CITY OF SALEM,MASSACHUSETTS
__;E1,' BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4'FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN@SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: _ Received By:
Complaint Number: 2181
Complainant --
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: