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: _____________________________________________________________________________

_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________