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Cruelty, Neglect or Abandoned Investigation Report

Note: Records are kept confidential

Date of incident:
Time of incident:
Your Information
Name:
Address:
City:
County:
Zip:
Phone:
Owner Information (if known)
Name:
Address:
City:
County:
Zip:
Closest intersection:
Detailed description:
Witnesses to incident:
Police contacted:	yes no

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Revised: October 18, 2006