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Barking Dog Complaint Update Form
1.
COMPLAINANT'S INFORMATION (Please provide your contact information, including apartment number, if applicable.)
Name:
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First
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Last
Address:
Street 1:
City/Town:
City/Town:
State / Province:
State / Province:
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CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
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KS
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ME
MI
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MO
MS
MT
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PE
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YT
None
Required
ZIP / Postal Code:
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ZIP / Postal Code:
Email:
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Email:
Mobile Phone:
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Mobile Phone:
2.
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Date of Violation:
Month
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Day
1
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Year
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1924
3.
Field Is Required
BARKING DOG DURATION (from when to when):
(Maximum response 255 chars, approx. 5 rows of text)
4.
DOG OWNER'S LAST NAME:
5.
DOG OWNER'S FIRST NAME:
6.
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ADDRESS OF BARKING DOG(s):
7.
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CITY:
8.
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STATE:
CA
9.
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ZIP:
10.
TELEPHONE OF DOG OWNER:
(Maximum response 255 chars, approx. 5 rows of text)
11.
DESCRIPTION OF BARKING DOG(s) IF KNOWN: (breed, color, size and gender)
12.
Field Is Required
Have you attempted to contact the dog owner regarding the issue?
Please select response
Yes
No
13.
IF YES, Please provide the name of party contacted and the date/time:
14.
WHAT HAPPENED?:
15.
Field Is Required
If you have previously reported this issue, please provide the case number for that complaint:
Spam Control Text:
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