191 FEDERAL STREET - HOUSING COMPLAINT (F rt, CITY OF SALEM, MASSACHUSETTS
�' �� � BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDINna SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2379
Complainant
Address: Phone: ,
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Investigated By: Date:;
Property Owner/occupant Name Telephone#:
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