UNION STREET - HOUSING COMPLAINT a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4'FLOOR
MAYOR A (978)741-1800 F Ax(978)745-U343343
LARRYRAMDIN,RS/REHS,CHO,CP-FS LRAMDIN(d.SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: '% Time: Received By:
Complaint Number: 2007
Complainant
Address: Phone:
Investigated By: Date:
Property Owner/Occupant Name_ Telephone #: _