23 Dearborn Street Complaint 8-19-2019 -
� �. CITY OF SAI,EM, MASSACHUSETTS
r e
BOARD OF HEALTH
KIMBERL.EY DRISCOLL 120 WASHINGTON STREET,4"FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDnj SALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
Date: Time: l a;3,oam Received By:
Complaint Number: 2541 _
Complainant — _
Address: 2. - Phone:
- _ fa
Investigated By: Date:
Property Owner/Occupant Name _ Telephone #:
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