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2. First Name*
3. Last Name*
5. Your Address*
7. City*
8. State*
9. Zip*
11. Phone Number*
12. Alt. Phone Number
13. Email Address
17. Complaint Address*
19. City*
20. State*
21. Zip*
25. Type of Complaint*
    -- Select One --StrayConfinedWelfare CheckBiteSickInjuredAbandonmentRoad KillBarkingWildOther
26. Type of Animal*
    -- Select One --DogCatLivestock (Cow, Goat, etc)Horse/Pony/DonkeyChicken/Duck/GeeseRaccoonOpossumRabbitDeerSkunkSnakeOther
27. Number of Animals
29. Descriptions/Comments
    Give descriptions of the animals or leave any additional comments on your complaint.
31. Upload Files
    You can upload files that may be important to your complaint.
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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

* indicates a required field