135 LAFAYETTE STREET - HOUSING COMPLAINT (2) atiurti�
CITY OF SALEM,MASSACHUSETTS
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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 LRAMDINCa)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: S ; !_'� rt; Received By:
Complaint Number: 2316
Complainant
Address- Phone:
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Investigated By: Date:
Property Owner/Occupant Name Telephone #:
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