55 HIGHLAND STREET - HOUSING COMPLAINT CTTY OF SALEM;MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL C� 120 WASHINGTON STREET,4Te FLOOR
TEL.(978)741-1800
MAYOR J ` ` I � FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS v LRAMDINnSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: _ Received By:
Complaint Number: 2233
Complainant
Address: Phone:
Investigated By: _ Date:
Property Owner/Occupant Name Telephone#:
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