135 LAFAYETTE STREET - HOUSING COMPLAINT cm)
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4Tf3 FLOOR
MAYOR A (978)741-1800 FAX
A (978)745-0343343
LARRY RAMDIN,RS'REHS,CHO,CP-FS LRAMDIN@SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: � �,;y�— Received By: /
Complaint Number: 19``74
Complainant
Address: '7 /G��% '� 6 ELAff Phone: l
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Investigated By: Date:
Property Oxvner/Occupant Name Telephone #: