112 NORTH STREET - HOUSING COMPLAINT hUliq
CITY OF SALEM, MASSACHUSETTS
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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 LRAMDINr2SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: -¢ Received By:
Complaint Number: 2236
Complainant ,
Address: ! 7 A>,. L h:1 Phone
Investigated By: Date: 1
Property Owner/Occupant Name _ Telephone #:
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