SALEM HEIGHTS - HOUSING COMPLAINT #A109 a
CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRY RAMDIN,RSIREHS,CHO,CP-FS LRAMDINr'SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: °" Received By:
Complaint Number: 2015
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone #: