Name of dog owner (If you don't know the name, please put Caretaker instead) * Address: * City: * State: * - - Choose One - - AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip: How Many Dogs? * Chained or Penned? * Chained Penned Backyard Other If 'Other', Please Explain May we contact you with questions? If so, provide e-mail address Does this Dog Appear to Be Abandoned? * No Yes Does this Dog Appear Sick or Injured? * Yes No Don't Know If Yes, Please Explain Has Animal Control or Humane Officer been contacted? * Yes No If Yes, What did they Say? Photo #1 Photo #2 English or Spanish * English Spanish Security Code *