2. Assumption Parish Police Jury
4. 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).
6. Date*
   Date
   Enter the date
8. First Name*
   Enter your first name
9. Last Name*
   Enter your last name
11. Address
    Enter your address
13. City
    Enter your city
14. Zip Code
    Enter your zip code
16. Email Address*
    Enter your email address
17. Phone Number
    Enter your phone number
19. Property Owners Name
    Enter the name of property owner that owns animal if applicable
21. Address to Property in Violation*
    Enter address of property or nearest address to where animal is located
23. City*
    Enter city of property in violation
24. Zip Code
    Enter zip code of property in violation
26. Description of Dangerous, Vicious or Fierce Animal*
    Enter a description of the dangerous, vicious or fierce animal
28. 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.

    1. I agree.
30. Electronic Signature*
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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