2. Date of this request
   Date of this request
4. First Name
5. Last Name
7. Address1
9. Address2
11. City
12. State
13. Zip
15. Daytime Phone Number
16. Email address
    Please double check your email address for accuracy and ensure that any email filter you use allows incoming email from the @co.iredell.nc.us domain, otherwise you may not receive our response.
20. Please answer the following questions to the best of your knowledge. If you do not know who filed the complaint or who the owner is, leave those questions blank.
22. 1. Name of person who filed complaint (if known)
23. 2. Date the complaint was filed *
    2. Date the complaint was filed
25. 3. Owner of animal complaint was filed against (if known)
27. 4. Address of the call (where it happened) *
29. 5. Type of complaint (loose animal, cruelty, etc.) *
31. 6. Type animal involved *
35. Indicate the format in which you wish to receive the requested record

    1. I want record emailed to the address above
    2. I want a paper copy of the records
37. Are you a party to this information?

    1. Yes
    2. No (Are you the caller or the animal owner?)
39. Electronic Signature*

    By checking below, you agree and acknowledge your electronic signature is valid and binding in the same force and effect as a handwritten signature.
    
    

    1. I agree
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field