Stipulated Order Violation

Please fill out all information below with as much detail as possible, including housing conditions and other observations. Please supplement your documented violation with photos or video where applicable. Also: Send any relevant attachments (photo or video) to When sending photos or video: please send from the same email address that you note in the below form, that way they can easily match up a submitted form with the secondary attachments. Thank You.

Your Name (required)

Your Email (required)

Date (xx/xx/xxxx)

Time (xx:xx AM/PM)

Animal ID (Axxxxxxx)

Animal Shelter

Name(s) of employee(s) you spoke to

Animal killed before statutory hold period expired? (yes or no)

Ill or injured animal not provided with veterinary care? (yes or no)

Animal euthanized that was not released to a rescue group that requested custody of the animal? (yes or no)

Detailed description of violation