278 LAFAYETTE STREET - HOUSING COMPLAINT =n CITY OF SALEM, MASSACHUSETTS
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\v� BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN 4nSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2341
Complainant
Address: Phone:
Investigated By: Date:
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Property Owner/Occupant Name +, ;: Telephone #:
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