League in Support of Animals
P.O. Box 740321, New Orleans, LA 70174   (504) 366-8972

CRUELTY REPORT

Print and fill out this form. Mail to the address above or have available
for reference and call the number above. Fields with a * must be filled out.

Name of Person Filing Report:

______________________________________________

Address:	_______________________________________________________________
	_______________________________________________________________

Phone:

(H)_____________________________

(W)_____________________________

Name of Person(s) Responsible for Abuse:

____________________________________

*Address:	______________________________________________________________
	______________________________________________________________

Phone:

(H)_____________________________

(W)_____________________________

*Description of Animal(s) involved:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Witnesses:_____________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

*Description of Incident(s) (include specifics if possible, e.g. time, date):

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Continue on reverse if necessary

Date:____________________________

Hosted by www.Geocities.ws