63 BUTLER STREET - TRASH & RODENT COMPLAINT CITY OF SALEM, MASSACHUSETTS
Y.y 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 LRAMDINia'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2175
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: