CITY OF ROCK FALLS, IOWA
ANIMAL NUISANCE COMPLAINT FORM

Name of person making complaint: ______________________________ Date________________
Address of person making complaint: ______________________________
Phone number of person making complaint: ______________________________
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Please provide the following information about the animal causing the nuisance:
1. Physical description of animal (please include any special markings): ______________________________________________________________________________
______________________________________________________________________________
2. Name of Owner or Keeper of the animal: _______________________
3. Address of Owner or Keeper of the animal: _______________________
_______________________
6. Phone number of Owner or Keeper of the animal: ________________
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Please check the type of nuisance that applies:
____ frequent howling, yelping, barking or making other noises that disturb the peace;
____ chasing, snapping at or impeding a pedestrian, bicyclist or vehicle;
____ damaging, soiling or defiling private or public property, other than his owner's on more than one occasion;
____ molesting or attacking a person or other animal.
Date(s) that alleged nuisance occurred: ___________________________________
Explain in detail the facts concerning the alleged violation: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
List here all evidence attached to this complaint (for example, photographs, written statements of neighbors, etc.):
__________________________________________________________________________________________
__________________________________________________________________________________________
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I certify that the information provided on this form is true. I certify that I personally witnessed this alleged violation of the ROCK FALLS, IOWA, Animal Nuisance Ordinance. I understand that I may be called to testify about these facts and I agree to do so.

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Signature of person making complaint Date