PRINCETON CROSSING - HOUSING COMPLAINT r�',covo�r�,
,- r CITY OF SALEM, MASSACHUSETTS
\k ,�,,5, BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHNGTON STREET,4TE'FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAINIMN,RS/REHS,CHO,CP-FS LRAMDINL7SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: J Time: _1 I ,. Received By:
Complaint Number: 1791
Complainant K ,)
Address: `q '- Val/ � �1?Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #:
i