71 CONGRESS STREET - HOUSING COMPLAINT CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR (978)741-1800 FAX
FAx(978)745-034343
LAP RY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN i)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By: _
Complaint Number: 2374
Complainant
Address: Phone:
Investigated By: _ _ Date:
Property Owner/Occupant Name Telephone #: _
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