292 ESSEX STREET - HOUSING COMPLAINT a
CITY OF SALEM,MASSACHUSETTS
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: Time: Received By:
Complaint Number: 2415
Complainant
Address: t� ,� l �. � � Phone:
r Investigated By: +r ! ,, P rnS Date:
Property Owner/Occupant Name- Telephone#:
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