284 WASHINGTON STREET - HOUSING COMPLAINT CITY OF SALEM, MASSACHUSETTS
a 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(a'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: 1�' Time: Received By:
Complaint Number: 2223
Complainant ,E: JdT trinl;-
Address: . Phone
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Investigated By: Date:
Property Owner/Occupant \ame Telephone#:
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