58 BRIDGE STREET - HOUSING COMPLAINT xuira� .
CITY OF SALEM MASSACHUSETTS
J; BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T'FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINCI SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2185
Complainant
Address: Phone:
Investigated By: _ Date:
Property Owner/Occupant Name _ Telephone #: