84-86 BAY VIEW AVENUE - HOUSING COMPLAINT CITY OF SALEM, MASSACHUSETTS
—_` — BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
p FAX(978)745-0343
�! LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINnSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: 7�'1 Time: Received By:
Complaint Number: 2209 -
Complainant ,
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Address: j l Phone:
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Investigated By: Date:
Property Owner/Occupant Name - Telephone #
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