LORING TOWERS - HOUSING COMPLAINT #A114 �C CITY OF SALEM,MASSACHUSETTS
?_ BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,e"FLOOR
MAYOR (978)741-1800
FAX
FAX(978)745-034343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: !% Time: Received By:
Complaint Number: 2365
Complainant
Address: Phone:
S I _
Investigated By: _ Date:
Property Owner/Occupant Name _Telephone #:
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