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2. Name*
3. Email Address*
5. Address*
7. City
8. State
9. Zip Code
11. Phone Number*
13. Address of animal(s) or incident:*
15. What type of animal(s) are you reporting?*

    1. Dog(s)
    2. Cat(s)
    3. Bird(s)
    4. Livestock
    5. Small house pets (rabbits, hamsters, mice, etc)
    6. Wildlife (deer, racoons, skunks, etc)
17. How many animals are you reporting?*
19. Nature of incident:*
21. Does the animal(s) have sufficient food?*
    -- Select One --YesNoUnknown
22. Does the animal(s) have sufficient water?*
    -- Select One --YesNoUnknown
23. Does this animal(s) have shelter?*
    -- Select One --YesNoUnknown
25. Describe the animal(s) condition?*
27. Please provide any additional information that you believe would be valuable during our investigation:
31. 
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

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