Your Information
Please fill out the following information so that we can contact you if we have any further questions. Failure to provide this information may result in the complaint being thrown out and/or regarded as faulty information or a bogus complaint.
*Your Name:
*Daytime Phone:
Evening Phone:
Mobile Phone:
E-Mail Address:
*Required fields. 

Animal Owner Information
Please provide as much information as possible.
Animal/Property Owner's Name:
Address Where Animals are Housed:
City, State, Zip Code:
Phone Number:
County Where Property is Located:
If you aren't sure about the exact address, please describe in detail, directions to the property:

Are there No Trespassing signs posted anywhere near the property?  

Animal Information
Please list all information you can about each animal on the property.
How many animals are on the property?
How many animals appear to need immediate assistance?
Please provide detailed descriptions of each animal: Animal #1 Species (dog, cat, horse, etc): Color and Markings: Gender: Body Condition (please be descriptive, ie: hip and ribs sticking out, rain rot covering 50% of body): Hoof Condition (for goats, horses, etc): Is this animal injured? Describe injuries: Repeat the above information for every animal if neccessary.

Please describe any shelter that the animals have access to:


Do the animals have access to clean, unfrozen water? Please describe.

Do the animals appear to have food available? Please describe.

Contact Information
Please provide the following information if you have already contacted a Law Enforcement Officer and/or Animal Control Officer.
Who did you call:
Law Enforcement Officer or Animal Control? Date Contacted: Officer's Name: Officer's Phone Number: Please provide any more information that you have from this contact.

Other Information
Please provide any other information that you have available:

Your Electronic Signature:

Date:

Pictures are the best proof of neglect. If you were able to take pictures of the animals please send them via e-mail to kelsey@animalprotectioncoalition.org or mail them to Animal Protection Coalition, Inc., 916 S. Prairie Ave., Frankfort, Indiana 46041.

Thank you for your concern about the animals!