82 FEDERAL STREET - HOUSING COMPLAINT CITY OF SALEM, MASSACHUSETTS
� BOARD OF HEALTH
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` 4- KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
J MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINaa SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: Time: Received By: V , 1,
Complaint Number: 2208_
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Address: `.7 _ Phone:ft
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Investigated By: Date:
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Property Owner/Occupant Name Telephone#:
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