62 LAWRENCE STREET - HOUSING COMPLAINT a
CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR A (978) 1-1800 FAX
A (978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDTN SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2073 -_
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: