17-21 Salem Street #1 Complaint 8-8-2019 CITY OF SALEM, MASSACHUSETTS
re BOARD OF HEALTH
KIMBERL D SCOLL 120 WASHINGTON STREET,4TH FLOOR
MAYOR TEL.(978)741-1800
FAX(978)745-0343
LARRY RAMDIN,RS/REHS,CHO,CP-FS LRAMDIN iVSALEM.COM
HEALTH AGENT
COMPLAINT INTAKE FORM
-� Received By:
Date: Time: /
Complaint Number: 2531 f
Complainant 1 Cd. 4
Address: Phone:-19
9
7
/I
-
Investigated By: Date:
Property Owner/Occupan,Name _ Telephone#: