Minnesota Federated Humane Societies
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MFHS Online Report Form
Reporting Party
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Indicates required field
Role in Report:
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Complainant
Law Enforcement
MFHS Agent
Veterinarian
First Name
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Preferred First Name
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Middle Name
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Last Name
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Would you come forward as a witness if needed:
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Yes
No
Witness Status:
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1st Hand Account
2nt Hand Account
Other
Please state your "Other" Witness Status:
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if Witness Status is "Other"
Are you providing Photo's, Videos or supporting evidence?:
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Yes
No
Relationship to AV (If Complainant)
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Neighbor
Friend
Relative
Other
Only if Role in Report is Complainant
Please state your "Other" Relationship to AV:
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Only if Role in Report is "Complainant" and Relationship to AV is "Other"
Email Address
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Home Phone Number:
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Work Phone Number:
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Cell Phone Number:
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Preferred Contact Method:
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Email
Mail
Primary Phone Number
Secondary Phone Number
Your Date of Birth (mm-dd-yyyy)
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Drivers License/OLN:
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State of Drivers License/OLN:
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Address
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Line 1
Line 2
City
State
Zip Code
Country
This is regarding
First Name
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Preferred First Name
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Middle Name
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Last Name
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Email Address
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Home Phone Number:
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Work Phone Number:
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Cell Phone Number:
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Preferred Contact Method:
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Email
Mail
Primary Phone Number
Secondary Phone Number
AV Date of Birth (mm-dd-yyyy)
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Drivers License/OLN:
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State of Drivers License/OLN:
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Report Details
Please describe why you are contacting us today:
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Incident Date (mm-dd-yyyy):
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Incident Date (HH:MM):
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AM/PM
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AM
PM
Option 3
Incident Date is:
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Actual Date
Reported Date
Other agencies that may already be involved such as, another organization or police department:
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Exact Address Known:
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Yes
No
County
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Describe the General Location:
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General Location - City:
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General Location - County:
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Suspected Violations of MN Animal Cruelty Statute 343.21
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Subdivision 1. Torture. No person shall overdrive, overload, torture, cruelly beat, neglect, or unjustifiably injure, maim, mutilate, or kill any animal, or cruelly work any animal when it is unfit for labor, whether it belongs to that person or to another person.
Subd. 2. Nourishment; shelter. No person shall deprive any animal over which the person has charge or control of necessary food, water, or shelter.
Subd. 3. Enclosure. No person shall keep any cow or other animal in any enclosure without providing wholesome exercise and change of air.
Subd. 4.Low feed. No person shall feed any cow on food which produces impure or unwholesome milk.
Subd. 5. Abandonment. No person shall abandon any animal
Subd. 6. Temporary abandonment. No person shall allow any maimed, sick, infirm, or disabled animal to lie in any street, road, or other public place for more than three hours after receiving notice of the animal's condition.
Subd. 7. Cruelty. No person shall willfully instigate or in any way further any act of cruelty to any animal or animals, or any act tending to produce cruelty to animals.
Subd. 8. Caging. No person shall cage any animal for public display purposes unless the display cage is constructed of solid material on three sides to protect the caged animal from the elements and unless the horizontal dimension of each side of the cage is at least four times the length of the caged animal. The provisions of this subdivision do not apply to the Minnesota State Agricultural Society, the Minnesota State Fair, or to the county agricultural societies, county fairs, to any agricultural display of caged animals by any political subdivision of the state of Minnesota, or to district, regional or national educational livestock or poultry exhibitions. The provisions of this subdivision do not apply to captive wildlife, the exhibition of which is regulated by section 97A.041*.
Subd. 8a. Harming a service animal. No person shall intentionally and without justification do either of the following to a service animal while it is providing service or while it is in the custody of the person it serves: (1) cause bodily harm to the animal; or (2) otherwise render the animal unable to perform its duties.
If animal is being treated cruelly, is abused, neglected or tortured. Descibe here:
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Choose any that apply
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Lack of or no shelter
Lack of or no potable water
Lack of or no food/poor quality
Poor condition of animals/deceased, sick or injured, matter fur, lack of or no vet care
If you checked "Poor condition..." above. Describe Here:
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Choose any that apply
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Unkempt kennel/housing (excessive feces/urine)
Lack of Exercise/Stuck in kennel or crates for lengthy periods of time
Environmental Conditions (temps are too hot or cold/bad weather/hazardous conditions)
Too many animals/hoarding
Suspected puppy/pet mill
Community cat assistance/TNR
If you checked any of the above, please use this space to provide additional information:
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Other
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If you haven't checked any of the above
Animal Description
Estimated Number of Animals:
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Type of Animal:
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Describe Body Type (thin, normal, obese) (ribs, backbone / spine, hip bone showing / protruding)? (Attach Body Scoring / Field ID Report / Intake Report):
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Condition of Animals (coat condition of animal, clean / matted / dirty / missing hair / unkempt / other). Describe:
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Describe Suspected Injuries or Possible Illness (visible limping / open wounds / bleeding / swelling / bruising / broken bones / infection / labored breathing / nasal or eye discharge / other) Do not diagnose / provide what you observed:
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Describe Temperament (friendly / aggressive / scared / timid / stand-offish, etc.):
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VETERINARY/MEDICAL (ATTACH VETERINARY RECORDS IF AVAILABLE)
UTD on Vaccinations?:
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Yes
No
Unknown
When last veterinary visit:
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Please attach Vet records at bottom
Is the animal used for medical purposes (trained therapy animal/emotional support/unknown)?:
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Yes
No
Unknown
Do the Animals Get Exercise?:
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Yes
No
Unknown
Property Description
Please describe the Property:
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Please attach supporting documents/photos/property records/aerial view below
DESCRIBE OVERALL ENVIRONMENT AND WHERE ANIMALS ARE KEPT
Interior - Dirty/Clean/Organized/Messy?:
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CommInterior - Are Feces/Urine/other bodily fluids (Human/Animal/Unknown) present and how much?:ent
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Exterior - Dirty/Clean/Organized/Messy?:
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Exterior - Are Feces/Urine/other bodily fluids (Human/Animal/Unknown) present and how much?:
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Are there any dangerous or sharp objects/anything that could be hazardous to humans or animals?:
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Yes
No
Unknown
Are there hazardous chemicals present?:
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Yes
No
Unknown
Are there firearms or weapons on the property?:
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Yes
No
Unknown
ChooseAre any of the following present on the property (enclosures/dog houses/kennels/shelters/barn/out building/lean to/fencing):One
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Yes
No
Unknown
Describe Air Quality (smells?)
Do the animals get fresh air?:
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Yes
No
Unknown
Are there fans?:
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Yes
No
Unknown
Do the fans have filters?:
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Yes
No
Unknown
To your knowledge, has law enforcement been to this property?:
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Yes
No
Unknown
Are you aware of any illegal drugs or drug usage?:
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Yes
No
Unknown
Are you aware of any substance abuse?:
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Yes
No
Unknown
Are you aware of any violence or abuse?:
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Yes
No
Unknown
Restraining orders or orders for protection?:
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Yes
No
Unknown
Describe any suspicious or potentially violent/dangerous behavior (if any):
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Are you aware of a social worker’s involvement with the AV or the AV’s family?:
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Yes
No
Unknown
Describe main dwelling and any unique features of the property
Color of house/trim:
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Attached or detached garage:
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Outbuildings (how many and describe):
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Describe Vehicles (Cars/Trucks/Mobile Home/Camper/Tractors/ATVs/Boats, etc.):
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Are they operational?:
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Yes
No
Unknown
What vehicles do you see coming and going?:
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Does anything stand out about this property? Describe something that sets this property apart from other neighboring properties:
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Personnel Involved in Case
If you have contacted any other organization pertaining to this complaint, please include that information below
Law Enforcement:
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Yes
No
Unknown
Animal Control:
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Yes
No
Unknown
Rescue/Shelter:
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Yes
No
Unknown
Veterinary Clinic:
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Yes
No
Unknown
Board of Animal Health Contacted:
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Yes
No
Human Services Department:
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Yes
No
City or County Attorney:
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Yes
No
Government Officials (City Planner):
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Yes
No
Fire Department:
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Yes
No
Any Other Organization/Personnel:
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Yes
No
I agree that the information provided here is correct:
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Yes
Upload includes the ability for upload of videos for 15 seconds or less. For larger videos please submit via email to "email address"
Upload File
*
Max file size: 20MB
Submit
Home
REPORT ANIMAL CRUELTY
How to Report Animal Cruelty
MFHS Online Report Form
RESOURCES
State and Federal Animal Welfare Laws
Companion Animal Resources
Equine Resources
Wildlife Resources
Veterinarian Resources
Educational Resources
Community Cats, Affordable Veterinary Resources & Participating Rescues
>
Participating Cat Rescues
Minnesota Humane Societies, Shelters & Rescues
MFHS Team Members
Donate
Wish List
Fundraising Campaigns
Employer Giving
Estate & Planned Giving
Legislation
ABOUT
Our Story and Mission
Investigations
Contact Us
Volunteer Opportunities
GET INVOLVED, BECOME A STATE HUMANE AGENT
>
Statewide Humane Agents
Become a Statewide Humane Agent
Statewide Humane Agent/Law Enforcement Training
