SALEM HEIGHTS - HOUSING, RODENT COMPLAINT /owrrq
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR T'EL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(w7SALEM.COM
HEALTH AGENT
-COMPLAINT INTAKE FORM
Date: Time: Received By:
Complaint Number: 2266
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name Telephone#: _