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2. First Name*
3. Last Name*
5. Your Address*
7. City*
8. State
9. Zip Code
11. Phone Number*
12. Alternate Phone Number
14. Email Address
16. Address of the Animal Complaint*
    Address requested for inspection
18. City*
19. State
20. Zip Code
22. Animal Owner Information if Known
24. What is the Nature of the Complaint?
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26. Submit

* indicates a required field