Animal Cruelty/Neglect Report Form Have you filed a report with another agency? * Required Yes No Which one?: * RequiredDate 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 * RequiredPhysical condition: * Required Underweight Healthy Overweight Other OtherInjury: Shot Stabbed Cut Beaten Bleeding Over-heated Eye/ear infection Embedded collar Unable to stand Other OtherWhere is the animal injured: Head Back Tail Leg Other Other * RequiredShelter: * Required None Available Please describe: * RequiredWater: * Required None Available Please describe: * RequiredFood: * Required None Available Spoiled Sanitation: * Required Feces Wet/muddy Trash Toxic waste Other Other: * RequiredSummary 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) * RequiredPhone (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 * RequiredAddress * 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