Animal Welfare Complaint Form
Complaint Against:
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
*
Please Select
Beaver
Box Elder
Cache
Carbon
Daggett
Davis
Duchesne
Emery
Garfield
Grand
Iron
Juab
Kane
Millard
Morgan
Piute
Rich
Salt Lake
San Juan
Sanpete
Sevier
Summit
Tooele
Uintah
Utah
Wasatch
Washington
Wayne
Weber
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Latitude
To find latitude and longitude on map. Right click on computer or hold finger down on location on app.
Longitude
Back
Next
Complainant Information
Person making the complaint
I would like to stay anonymous:
No
Yes
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred contact method
Phone
Email
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Back
Next
Complaint
Date of first incident
-
Month
-
Day
Year
Date
Nature of the Complaint (Choose all that apply)
Animal Cruelty
Animal Welfare
Inadequate Care
Inadequate food or water
Inadequate shelter
Poor body condition score
Abandonment
Other
Species and number involved:
Description (please be concise and specific and put complaints in time-order)
Please attach any supporting documents or photos.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Certification Statement
I certify that the statements made by me in this complaint are true and any documents attached are true copies. I am aware that is any statements made by me are willfully false, I am subject to punishment.
Submit
Should be Empty: