LORING TOWERS - HOUSING COMPLAINT i
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-an m CITY OF SALEM, MASSACHUSETTS
"���� BOARD OF HEALTH ; �r
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR
MAYOR (978)741-1800 FAx
FAx(978)745-0343343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDTN(a)SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2117
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #:
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