Neglect Report - Maui Humane Society

Date Witnessed:*

Location of Neglected Animal(s):*

Try to be as specific as possible and provide an address when available.

Address of Neglected Animals (if known):

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Animal Details:*

Please provide any known details about the animals involved (e.g.- species, breed, color, and number of animals when possible).

Physical condition of the animal(s):

Please describe the animal's physical condition (i.e. - thin, matted fur, broken bones, open wounds, etc.)

Does the animal have access to food, water and shelter? If not, please describe:

Offending Party's Name (if known):

First Last

Offending Party's Address (if known):

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Offending Party's Phone Number (if known):

Offending Party's Vehicle Information, if applicable:

Please include make/model/color/license plate # or any information that may be helpful.

**FOR OFFICER SAFETY** Please provide any potentially dangerous information (drug use/weapons/previous history of violent behavior):

Your Name:*

First Last

Every reporting party is kept anonymous. Your identity and information will not be released to anyone outside our agency except by order of the court.

Your Phone Number:*

So that we can contact you to follow up if needed.

Your Email Address:*

Your Address:

Street Address Address Line 2 City State ZIP Code

If you have images you would like to upload to supplement your report, you can upload them here:

Drop files here or

Max. file size: 50 MB.