Fillable Commonwealth of Massachusetts County of Worcester (City of Worcester)

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Commonwealth of Massachusetts County of Worcester (City of Worcester)

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U.S.A. forms for City of Worcester

BROWSE CITY OF WORCESTER (MA) FORMS

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Commonwealth of Massachusetts
County of Worcester
Complaint of Vicious or Barking Dogs
Section 157, Chapter 140, General Laws
To
CHIEF OF POLICE
CITY OF WORCESTER Date____________
I hereby make complaint hereon, that a dog or dogs owned or harbored by
NAME ADDRESS
residing in my vicinity on or near ___________________________________________
is a nuisance by reason of:
A complete detail of the nature of your complaint: (please print)
The person appeared ____________________ and swore that the foregoing is a true
statement to the best of my knowledge and believe.
_____________________________
Notary Public
My Commission Expires
_________
This complaint is made under the penalties of perjury.
Complainant’s signature and address:
_____________________________
Print Form
Investigation of Vicious or Barking Dogs
Section 157, Chapter 140, General Laws
CITY OF WORCESTER Date____________
Upon complaint of _______________________________________________________
Name Address
made under the penalties of perjury and filed on ______________________ it is hereby
Date
ordered that _______________________________________ shall investigate forthwith
such complaint including an examination of facts and conditions as exist in connection
with the case and hereon make a report of your findings to me.
Chief of Police:
________________________________
________________________________
________________________________
Report on above investigation.
Investigator ______________________________________
Address _________________________________________
Report filed
(date)_____________________________20____
MASSACHUSETTS JURAT
Gov. Exec. Ord. #455 (03-13) §5(e)
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Commonwealth of Massachusetts }
County of Worcester }ss.
On this the ___________ day of _________________________________, __________
day month year
before me, _____________________________________________________________
name of Notary Public
the undersigned Notary Public, personally appeared
Names(s) of Signer(s)
proved to me through satisfactory evidence of identity, which was/were:
Description of Evidence of Identity
to be the person(s) whose name(s) is/are signed on the preceding or attached
document in my presence, and who swore or affirmed to me that the contents in
the document are truthful and accurate to the best of his/her/their knowledge
and belief.
______________________________________________
Signature of Notary Public
______________________________________________
Printed Name of Notary Public
My commission expires: __________________________
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Commonwealth of Massachusetts County of Worcester (City of Worcester)

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Completed 19 January 2021

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