50-52 ROSLYN STREET - HOUSING COMPLAINT = Rgi CITY OF SALEM, MASSACHUSETTS
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BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'{FLOOR
MAYOR TEL.(978)741-1800
l` FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINNa SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2388 - -
Complainant -
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #:
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