Form DCF-736 "Notification to Department of Agriculture of Suspected Animal Harm, Neglect or Cruel Treatment" - Connecticut

What Is Form DCF-736?

This is a legal form that was released by the Connecticut State Department of Children and Families - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2016;
  • The latest edition provided by the Connecticut State Department of Children and Families;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DCF-736 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Children and Families.

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Download Form DCF-736 "Notification to Department of Agriculture of Suspected Animal Harm, Neglect or Cruel Treatment" - Connecticut

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Department of Children and Families
NOTIFICATION TO DEPARTMENT OF AGRICULTURE of SUSPECTED ANIMAL HARM, NEGLECT OR CRUEL TREATMENT
DCF-736
Page 1 of 1
3/16 (New.)
FAX TO: 860-713-2515
or
E-MAIL:
Agr.animalcontrol@ct.gov
This form must be faxed to the Chief Animal Control Officer at the Connecticut Department of Agriculture within 48 hours of learning of the
suspected harm, neglect or cruel treatment of an animal.
Suspected harm, neglect or cruel treatment occurred on:
Date:
Time:
A.m.
P.m.
Last Name of Animal Owner
First Name of Animal Owner
Telephone # of animal owner:
LINK #:(if applicable):
Address of animal owner /other person responsible for its care
City:
State:
Zip:
Species of animal:
Breed:
Name of Animal:
Age:
Gender:
Color/Markings
NATURE AND EXTENT OF HARM, NEGLECT OR CRUEL TREATMENT TO THE ANMAL: (If this is related to a DCF case, do not give details of
the case; only describe the harm to the animal.
HOW DID YOU LEARN OF THE SUSPECTED HARM, NEGLECT OR CRUEL TREATMENT? (If this is related to a DCF case, do not give details
of the case; simply state how you came across the information, e.g., home visit.)
Last Name of suspected perpetrator of animal cruelty:
First Name of suspected perpetrator of animal cruelty:
Address of animal owner /other person responsible for its care
City:
State:
Zip:
Previous history of animal cruelty, if known:
Name of DCF Social Worker:
Signature of DCF Social Worker:
Date:
Name of DCF Social Work Supervisor:
Signature of DCF Social Work Supervisor:
Date:
Social Worker Phone Number:
DCF Office:
Please Select DCF Office
Agr.animalcontrol@ct.gov
Fax or email this form to: Connecticut Department of Agriculture
Fax: 860-713-2515
or
E-Mail:
\]
Department of Children and Families
NOTIFICATION TO DEPARTMENT OF AGRICULTURE of SUSPECTED ANIMAL HARM, NEGLECT OR CRUEL TREATMENT
DCF-736
Page 1 of 1
3/16 (New.)
FAX TO: 860-713-2515
or
E-MAIL:
Agr.animalcontrol@ct.gov
This form must be faxed to the Chief Animal Control Officer at the Connecticut Department of Agriculture within 48 hours of learning of the
suspected harm, neglect or cruel treatment of an animal.
Suspected harm, neglect or cruel treatment occurred on:
Date:
Time:
A.m.
P.m.
Last Name of Animal Owner
First Name of Animal Owner
Telephone # of animal owner:
LINK #:(if applicable):
Address of animal owner /other person responsible for its care
City:
State:
Zip:
Species of animal:
Breed:
Name of Animal:
Age:
Gender:
Color/Markings
NATURE AND EXTENT OF HARM, NEGLECT OR CRUEL TREATMENT TO THE ANMAL: (If this is related to a DCF case, do not give details of
the case; only describe the harm to the animal.
HOW DID YOU LEARN OF THE SUSPECTED HARM, NEGLECT OR CRUEL TREATMENT? (If this is related to a DCF case, do not give details
of the case; simply state how you came across the information, e.g., home visit.)
Last Name of suspected perpetrator of animal cruelty:
First Name of suspected perpetrator of animal cruelty:
Address of animal owner /other person responsible for its care
City:
State:
Zip:
Previous history of animal cruelty, if known:
Name of DCF Social Worker:
Signature of DCF Social Worker:
Date:
Name of DCF Social Work Supervisor:
Signature of DCF Social Work Supervisor:
Date:
Social Worker Phone Number:
DCF Office:
Please Select DCF Office
Agr.animalcontrol@ct.gov
Fax or email this form to: Connecticut Department of Agriculture
Fax: 860-713-2515
or
E-Mail:
\]