159 BRIDGE STREET - HOUSING COMPLAINT a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
rat MAYOR TEL.(978)741-1800
745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS
LRAMDIN r SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By-.
Complaint Number: 2072
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone#: