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Humane Complaint Form
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I am internal employee attaching a scanned document.
Date:
Date
form field Date:
must be in the format: MM/dd/yyyy
Complainant Information
Name:
*
Address:
*
City:
*
County:
*
Value is not selected
-- Select one --
ATLANTIC
BERGEN
BURLINGTON
CAMDEN
CAPE MAY
CUMBERLAND
ESSEX
GLOUCESTER
HUDSON
HUNTERDON
MERCER
MIDDLESEX
MONMOUTH
MORRIS
OCEAN
PASSAIC
SALEM
SOMERSET
SUSSEX
UNION
WARREN
OUTSIDE NJ
State:
*
Value is not selected
-- Select one --
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code:
*
Form field Zip Code: has
Invalid numeric value.
Phone Category
Value is not selected
-- Select one --
Cell
Fax
Home
Work
Preferred Telephone Number:
Phone
form field Preferred Telephone Number:
must be in the format: (000) 000-0000
Email Address:
Email Address 2:
*
Email
form field Email Address 2:
is not in correct form
I wish to remain anonymous
Complaint Against
Name:
Address:
*
City:
*
County:
*
Value is not selected
-- Select one --
ATLANTIC
BERGEN
BURLINGTON
CAMDEN
CAPE MAY
CUMBERLAND
ESSEX
GLOUCESTER
HUDSON
HUNTERDON
MERCER
MIDDLESEX
MONMOUTH
MORRIS
OCEAN
PASSAIC
SALEM
SOMERSET
SUSSEX
UNION
WARREN
OUTSIDE NJ
State:
*
Value is not selected
-- Select one --
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code:
Form field Zip Code: has
Invalid numeric value.
Phone Category
Value is not selected
-- Select one --
Cell
Fax
Home
Work
Preferred Telephone Number:
Phone
form field Preferred Telephone Number:
must be in the format: (000) 000-0000
Phone Category
Value is not selected
-- Select one --
Cell
Fax
Home
Work
Alternate Telephone Number:
Phone
form field Alternate Telephone Number:
must be in the format: (000) 000-0000
Email Address:
Email
form field Email Address:
is not in correct form
Complaint
Dates of Alleged Cruelty:
To:
*
Date
form field To:
must be in the format: MM/dd/yyyy
From:
*
Date
form field From:
must be in the format: MM/dd/yyyy
*We do care about the welfare of all animals, but the NJ Dept. of Agriculture has authority to investigate animal cruelty complaints involving livestock only, not pets or wildlife.
*For PETS, please reach out to your Local Humane Law Enforcement Officer (HLEO)
*For WILDLIFE, please reach out to NJ Dept. of Environmental Protection (NJDEP)
Livestock Species Involved:
*
Livestock Species Involved:
Cattle
Equine (Horse/Pony/Mule)
Goat/Sheep
Llama/Alpaca
Ostrich/Emu/Rhea
Poultry (Chicken/Duck/Goose)
Rabbit
Swine (Pig)
What is the nature of the complaint?
*
Please describe the facts of your complaint in the order in which they happened. Please be specific and print clearly.
*
Attach any supporting documents
Form field Attach any supporting documents has
Invalid files.
I certify that the statements made by me in this complaint are true and any documents attached are true copies. I am aware that if any statements made by me are willfully false, I am subject to punishment.
*
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Signature
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Date
Date
form field Date
must be in the format: MM/dd/yyyy
Internal User Email:
Email
form field Internal User Email:
is not in correct form
Email Address:
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