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2. 
3. DOG COMPLAINT
5. COMPLAINANT INFORMATION
7. DATE OCCURRED*
8. NAME OF INDIVIDUAL FILING COMPLAINT*
9. CONTACT #:*
11. EMAIL ADDRESS:
12. STREET ADDRESS*
14. INFORMATION TO BE COMPLETED REGARDING THE DOG
16. NAME OF OWNER (IF UNKNOWN, ENTER "UNKNOWN")*
17. OWNER ADDRESS/WHERE DOG RESIDES*
19. COAT:*

    1. SHORT
    2. LONG
    3. CURLY
    4. WIRY
    5. OTHER
20. TAIL:*

    1. SHORT
    2. LONG
    3. BUSHY
    4. RING
    5. OTHER
21. EARS*

    1. CROPPED
    2. DROPPING
    3. ERECT
    4. OTHER
22. COLLAR:*

    1. CHAIN
    2. LEATHER
    3. NONE
    4. OTHER
24. OTHER INFORMATION/DESCRIPTION OF DOG (SIZE, COLOR, BREED). IF NONE, PLEASE ENTER "NONE"*
26. PLEASE PROVIDE DETAILED DESCRIPTION OF EVENT(S)
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

* indicates a required field