51 SALEM STREET - HOUSING COMPLAINT CITY OF SALEN#,MASSACHUSETTS
0 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(a-tSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: e Received By: �
Complaint Number: 2282
Complainant
Address: a ' Phone:
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Investigated By: Date:
Property Owner/Occupant Name Telephone #: