Your full name
*
Address: (No P.O. Box)
*
City, State, Zip
*
Email Address
*
Your Phone Number
*
Nature of Complaint(please provide as much detail as you can)
*
What address is this animal located? (Street #, Steet name, City, State)
*
Does the animal have access to food, water and shelter?
Yes
No
Does the animal have apparent injuries that have not been treated?
Yes
No
Does the animal appear to be overly aggressive or timid?
Yes
No
Does the animal appear to be neglected? (Neglect is vaguely defined as failure to provide an animal with necessary food, water, shelter, rest, sanitation, ventilation, space, or medical attention.)
Yes
No
How long has this been going on?
Have you reported this to anyone else? If so, who?
*
Do you want to remain anonymous ?
*
Yes
No
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