409 ESSEX STREET - HOUSING COMPLAINT CITY OF SALEM, MASSACHUSETTS
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BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4 FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN«r SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2389
Complainant _
Address: Phone:
Investigated By: r Date: `fib nT � 9
Property Owner/Occupant Name Telephone#:
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