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Dangerous or Vicious Animal Report Form

  1. Assumption Parish Police Jury
  2. To the Assumption Parish Police Jury:
    The undersigned of the Parish of Assumption does hereby file complaint that the property owner stated below is in violation of the Assumption Parish dangerous, vicious and fierce animal ordinance (00-16).
  3. Enter the date
  4. Enter your first name
  5. Enter your last name
  6. Enter your address
  7. Enter your city
  8. Enter your zip code
  9. Enter your email address
  10. Enter your phone number
  11. Enter the name of property owner that owns animal if applicable
  12. Enter address of property or nearest address to where animal is located
  13. Enter city of property in violation
  14. Enter zip code of property in violation
  15. Enter a description of the dangerous, vicious or fierce animal
  16. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  17. Leave This Blank:

  18. This field is not part of the form submission.