SALEM HEIGHTS - HOUSING COMPLAINT #B901 ��amr'd
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,RS/REHS,CHO,CP-FS LRAMDrNO SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2096
Complainant
Address: Phone:
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Investigated By: Date:
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Property Owner/Occupant Name YWCA Telephone#:,
47-riL f VZJ 41,11-3
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