292 ESSEX STREET - HOUSING COMPLAINT (2) a
CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T}3 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: Time: Received By:
Complaint Number: 2330
Complainant
Address: ` ' :� ,� _� y ` cif m,-� --56, Phone:_
Llei t�-1 f'��•�'%����-�-.---.r i
Investigated By: /��(� Date:
- v
Property Owner/Occupant Name _ Telephone :