Animal Cruelty/Neglect Report Form Have you filed a report with another agency? * Required Yes No Which one?: * Required Date of incident * Required MM slash DD slash YYYY Have you seen the animal(s) since the incident? * Required Yes No Date of last seen animal(s) since the incident * Required MM slash DD slash YYYY Time of last seen animal(s) since the incident * Required : Hours Minutes AM/PM AM PM AM/PM Location of incident: * RequiredBe as specific as possible. Type of animal(s): * Required Dog Cat * RequiredColorBreedSize Skin/coat condition: * Required Hair loss Mange Sores Fleas/ticks Matting Other Other * Required Physical condition: * Required Underweight Healthy Overweight Other Other Injury: Shot Stabbed Cut Beaten Bleeding Over-heated Eye/ear infection Embedded collar Unable to stand Other Other Where is the animal injured: Head Back Tail Leg Other Other * Required Shelter: * Required None Available Please describe: * Required Water: * Required None Available Please describe: * Required Food: * Required None Available Spoiled Sanitation: * Required Feces Wet/muddy Trash Toxic waste Other Other: * Required Summary of incident/concern: * RequiredYour Information:*Please know that your personal information is kept confidential. In the event we have additional questions or need to follow up about a concern, we will need your contact information to do so. Your Information: * Required I would prefer to remain anonymous I will include my contact information Name * Required First Last Address * Required Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone (primary) * Required Phone (secondary) Email * Required Animal Owner's/Suspect's Information:Animal Owner/Suspect Information: * Required Unknown I know the Animal Owner's/ Suspect's contact Information Name * Required First Last Relationship to animal owner/suspect * Required Address * Required Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone (primary) Phone (secondary) Email Vehicle DescriptionMake: Model: Color: License Plate: Other: * Required I do not wish to be contacted. I would like to hear from a Humane Officer about this report. Δ