62 LEACH STREET - HOUSING COMPLAINT CITY OF SALEM MASSACHUSETTS
r_ 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 LRAMDIM&SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: b' Time: Received B -�-y:
Complaint Number: 2232
Complainant
Address: _ /. _ Phone: rr
Investigated By: i ✓ Date:
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