Signed Complaint Form
This form is to be used as a “witness statement” and should contain detailed and descriptive information that would be helpful for use in criminal proceedings. The submission of this form is paramount for the successful prosecution of your case and once submitted you must be willing to testify to the information contained herein. It is recommended that this form be completed as soon as possible after an incident takes place to ensure an accurate recollection of pertinent details and events. When describing animals, please use descriptive language when describing the animal’s behavior. For example, it is better to say- “the dog lunged at me with hackles on his back standing up and bared its teeth” rather than saying- “the dog appeared aggressive”.
Today's Date:
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Month
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Day
Year
Date
Date of Incident:
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Month
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Day
Year
Date
Time of Incident:
Hour Minutes
AM
PM
AM/PM Option
Animal Description:
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Owner Name:
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Owner Address:
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Incident Description:
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Witness Name:
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(First and Last Name)
Witness Phone:
Witness Email
example@example.com
Witness Address:
ASO:
I swear and affirm the above written statement is true and factual to the best of my knowledge. I understand that this Signed Complaint Form will be used in a legal proceeding and I acknowledge that it will become part of a legal record. By signing this complaint, I agree to appear as a witness in a legal proceeding regarding this matter.
Signature
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