49 ESSEX STREET - HOUSING COMPLAINT CITY OF SALEM MASSACHUSETTS
a BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4Tw FLOOR
MAYOR (978)741-1800 FAX
� FAx(978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(4fSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2009
Complainant ;
Address: ' t Phone:
r
Investigated By: Date: -
Property Owner/Occupant Name Telephone #: