195 JEFFERSON AVENUE - HOUSING COMPLAINT uir
( n CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TF'FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRYRAMDIN,RS/REHS,CHO,CP-FS LRAMDIN-a SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: 1 Received By:
Complaint Number: 2085 -
Complainant
Address: Phone:
Investigated By: _ Date: - - -
Property Owner/Occupant Name Telephone#