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2. Fields marked with an * are required to print this form. Anonymous submissions are not accepted.
4. Your Last Name*
5. Your First Name*
6. Middle Name
8. Your Address
   Please enter your residential address. This should be in close proximity to the noise.
10. Street Number*
11. Street Name*
12. Apt./Unit #
14. City (Antioch excluded)*
    Antioch residents, please contact Antioch Animal Services at 925-779-6989
15. State*
16. Zip*
18. Home Phone*
19. Other Phone
20. Email Address*
    Enter "none" if you don't have an email address
22. Mailing address if different from above:
24. Street Number
25. Street Name
26. Apt./Unit #
28. City
29. State
30. Zip
34. Noisy Animal Information
    Please enter in only one address per form. PLEASE NOTE: Per Department policy, we allow one complaint per household, when there has been an initial report filed, and the 15 day compliance period is in effect. or noisy animals located in Antioch, please call Antioch Animal Services at 925-779-6989 to file a complaint.
36. Owner's Last Name
37. Owner's First Name
39. Street Number*
40. Street Name*
41. Apt./Unit#
43. City*
44. State*
45. Zip*
47. Home phone
49. Date and time of violation
    Please enter the starting day and time and ending day and time in a 24 hour period only. Please remember that midnight is 12:00 am.
51. Starting on*
    Starting on
52. at*
    at
53. Select one*

    1. Incessant
    2. Intermittent
55. Ending on*
    Ending on
56. at*
    at
58. Description of noisy animal if known
60. Animal Type*
61. Color
62. Size

    1. Small
    2. Medium
    3. Large
    4. Unknown
63. Gender

    1. Male
    2. Female
    3. Unknown
65. Other responsible party's name(s):
67. Relationship to owner
69. Have you attempted to contact the owner or any other responsible party?*

    1. Yes
    2. No
71. What occurred when you made contact with the owner/responsible party?
73. Click submit when you are done
    After clicking Submit, you will be taken to a page with information on next steps.
Leave This Blank:


75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit Submit and Print

* indicates a required field