SALEM HEIGHTS - HOUSING COMPLAINT - BUILDING B, 4TH FLOOR CITY OF SALEM, MASSACHUSETTS
�eeirvio-J/ BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAx(978)745-0343
LARRI'RAMDIN,RS!REHS,CHO,CP-FS LRAMDIN Ot SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
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Date: '. �6i Time: F' �, A� .t :J:+ Received By: J y
Complaint Number: 1999
Complainant i V ti ML"���n v�o
17 Address: Phone
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Investigated By: Date:
Property Owner/Occupant Name Telephone #:
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