LORING TOWERS - HOUSING COMPLAINT #C23 �= 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 RAMDW,RS/REHS,CHO,CP-FS LRAMDINCa?SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: 1 `'`I Time: Received By:
Complaint Number: 1792
Complainant
Address: _Phone ', .� ?4- �
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Arc)(Investigated By: Lk�A— Date:
Property Owner/Occu ant Name Telephone #: