2. Date*
   Date
4. Complainant's First Name*
5. Complainant's Last Name*
7. Email Address*
8. Phone Number*
10. Address*
11. City*
13. State*
14. Zip Code*
16. Date of Complaint/Incident*
    Date of Complaint/Incident

    Date of Complaint/Incident
17. Location Where Complaint/Incident Occurred*
19. Dog Owner's Name (if known):
20. Dog Owner's Phone Number (if known)
22. Dog Owner's Address (if known)
24. Description of Dog in Question
26. Was Dog Wearing Collar/ID?

    1. Yes
    2. No
28. Please Describe What Happened
30. Desired Outcome
32. Was A Police Report Made?

    1. Yes
    2. No
33. If So, Please Provide The Event Number (police report number if known)
35. If Violations Exist, Do You Wish To Ticket* The Dog Owner Through The Animal Control Department

    *Please note, by doing so the dog owner has the right to know who you are, your complaint will no longer be kept as an anonymous complaint.

    1. Yes
    2. No
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37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

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