161 BOSTON STREET - HOUSING COMPLAINT �j;ntiUfTq�
a CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAx(
LARRY RAMDIIN,RS/REHS,CHO,CP-FS
LRAMDINCa�ALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2041
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: