293 LAFAYETTE STREET - HOUSING COMPLAINT CITY OF SALEM,MASSACHUSETTS
a BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,,f"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(aSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM r
Date: Time: Received By: I �
Complaint Number: 2364
Complainant
Address: Phone:!
Investigated By: Date:
Property Owner/Occupant Name Telephone #:
ILA
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