"Dog Seizure and Disposition Report" - New York

Dog Seizure and Disposition Report is a legal document that was released by the New York State Department of Agriculture and Markets - a government authority operating within New York.

Form Details:

  • Released on March 1, 2014;
  • The latest edition currently provided by the New York State Department of Agriculture and Markets;
  • Ready to use and print;
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  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New York State Department of Agriculture and Markets.

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Download "Dog Seizure and Disposition Report" - New York

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Rev Mar2014
DOG SEIZURE AND DISPOSITION REPORT
TOWN/CITY/VILLAGE
COUNTY
DOG CONTROL RECORD NUMBER
DATE SEIZED BY OFFICER
TIME SEIZED
LOCATION WHERE SEIZED
REASON FOR SEIZING
NAME OF SEIZING OFFICER
NAME/ADDRESS OF SHELTER
DATE RECEIVED AT SHELTER_____________________
RECEIVED BY
IF NOT REDEEMED, DATE AVAILABLE FOR SUBSEQUENT DISPOSITION
DOG DESCRIPTION:
BREED
SEX
COLOR
AGE
LICENSE TAG NUMBER
OTHER ID
MUNICIPALITY
NOTES:
OWNER INFORMATION, IF KNOWN:
NUMBER OF IMPOUNDMENTS PAST 12 MONTHS
NAME OF OWNER OF RECORD
OWNER ADDRESS
OWNER NOTIFIED? DATE & METHOD
_____________________________________
_ _
DISPOSITION OF DOG:
REDEEMED BY OWNER: DATE
IMPOUNDMENT FEE PAID $
DOG LICENSE NUMBER
ISSUED BY
EUTHANIZED: DATE
PERFORMED BY
ADOPTED: DATE
ADOPTION FEE $
TRANSFERRED: DATE
NAME/ADDRESS OF SHELTER
NOTE: TRANSFER ONLY TO A MUNICIPAL SHELTER OR AN INCOPORATED SPCA, HS OR DOG PROTECTIVE ASSOC.
SEIZURE CODES:
1. UNIDENTIFIED & AT LARGE §117.1a
4. DEER QUARANTINE §120
7. LOCAL LAW VIOLATION
2. UNLICENSED §117.1b
5. NIGHT QUARANTINE §121
8. COURT ORDER
3. THREAT TO PUBLIC SAFETY §117.1c
6. DANGEROUS DOG §123
9. OTHER (STATE REASON)
Rev Mar2014
DOG SEIZURE AND DISPOSITION REPORT
TOWN/CITY/VILLAGE
COUNTY
DOG CONTROL RECORD NUMBER
DATE SEIZED BY OFFICER
TIME SEIZED
LOCATION WHERE SEIZED
REASON FOR SEIZING
NAME OF SEIZING OFFICER
NAME/ADDRESS OF SHELTER
DATE RECEIVED AT SHELTER_____________________
RECEIVED BY
IF NOT REDEEMED, DATE AVAILABLE FOR SUBSEQUENT DISPOSITION
DOG DESCRIPTION:
BREED
SEX
COLOR
AGE
LICENSE TAG NUMBER
OTHER ID
MUNICIPALITY
NOTES:
OWNER INFORMATION, IF KNOWN:
NUMBER OF IMPOUNDMENTS PAST 12 MONTHS
NAME OF OWNER OF RECORD
OWNER ADDRESS
OWNER NOTIFIED? DATE & METHOD
_____________________________________
_ _
DISPOSITION OF DOG:
REDEEMED BY OWNER: DATE
IMPOUNDMENT FEE PAID $
DOG LICENSE NUMBER
ISSUED BY
EUTHANIZED: DATE
PERFORMED BY
ADOPTED: DATE
ADOPTION FEE $
TRANSFERRED: DATE
NAME/ADDRESS OF SHELTER
NOTE: TRANSFER ONLY TO A MUNICIPAL SHELTER OR AN INCOPORATED SPCA, HS OR DOG PROTECTIVE ASSOC.
SEIZURE CODES:
1. UNIDENTIFIED & AT LARGE §117.1a
4. DEER QUARANTINE §120
7. LOCAL LAW VIOLATION
2. UNLICENSED §117.1b
5. NIGHT QUARANTINE §121
8. COURT ORDER
3. THREAT TO PUBLIC SAFETY §117.1c
6. DANGEROUS DOG §123
9. OTHER (STATE REASON)