The Hawaiian Humane Society has provided a citizen complaint from for Hawaii Residents to use when reporting pet related offences. Below is an example of the form. To download a pdf of the file click on the pdf icon to the right.
Citizen Complaint Form - Domestic Pets
Are you the: Complainant Witness Victim Animal Owner/Keeper Responding to complaint
Name: ________________________________________________________________________
Address: _________________________________ City: _________________ Zip: ___________
Home Phone: ______________ Business Phone: ______________ Cell Phone: _____________
Type of incident:
[ ] Loose Dog
[ ] Animal Bite
[ ] Animal Abandonment
[ ] Barking Dog
[ ] Animal Cruelty/Neglect Other (specify) ____________
Animal Owner (if known):________________________________________________________
Owner’s Address _________________________________ City: ______________ Zip: _______
Animal Description (type of coat, size, breed, approximate weight, color, age, etc.):
______________________________________________________________________________
______________________________________________________________________________
Incident Date: __________________________ Incident Time:________________________
Incident Location: _____________________________________________________________
HPD report filed: Yes / No Report No.: ____________________________________
Are you willing to appear in court if necessary? Yes / No
Was the animal teased or provoked? Yes / No
Was a person trespassing or threatening to trespass? Yes / No
Was the animal making noise continuously for 10 minutes? Yes / No
Was the animal making noise intermittently for a half-hour or more? Yes / No
This has been prepared by:
Myself / Other (name) __________________________________ I declare under penalty of law that my responses and statements in this form are true and correct.
_______________________________ _______________________ ______________
Signature Date Time
CASE # ___________________
I freely give the following statement: _____________________________________________________________________________
_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________