Fillable ANIMAL CONTROL DIVISION COMPLAINT REPORT (City of Des Moines)

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ANIMAL CONTROL DIVISION COMPLAINT REPORT (City of Des Moines)

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The ANIMAL CONTROL DIVISION COMPLAINT REPORT (City of Des Moines) form is 1 page long and contains:

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Country of origin: US
File type: PDF

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ANIMAL CONTROL DIVISION
COMPLAINT REPORT
Complainant:
_______________________________________________________________________
Last Name First Middle Date of Birth
Address: _______________________________________________________________
Number/Street City State Zip
Phones:_________________________________________________________________
Home Work Other
Number of pets owned: Cats:____ Dogs:____ License Numbers:________________
Violator:
_______________________________________________________________________
Last name First Middle Date of Birth
Address: _______________________________________________________________
Number/Street City State Zip
Phones: ________________________________________________________________
Home Work Other
Number of pets owned: Cats:____ Dogs:____ License Numbers:________________
Description of violating pet(s):_____________________________________________
Narrative of violation: On this date:_____________ at this time:____________AM/PM
at this location: ___________________________________________________________
the following occurred: ____________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
“I certify (or declare) under penalty of perjury under the laws of the State of Washington
that the foregoing is true and correct; that I am willing to testify to this in a court of
law.” RCW 9A.72.085
Signature: ______________________________________________ Date: _________
Officer: __________________________
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ANIMAL CONTROL DIVISION COMPLAINT REPORT (City of Des Moines)

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Completed 2 May 2021

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