Fill and Sign the Dc 397 Affidavit for Warrant for Depredation by Dog Master Form

AFFIDAVIT FOR WARRANT – DEPREDATION BY DOG ..................................................................................... . OWNER OF DOG (LAST, FIRST, MIDDLE NAME) ..................................................................................... . ADDRESS ..................................................................................... . CITY/STATE TELEPHONE NUMBER ..................................................................................... . OWNER OF DOG (LAST, FIRST, MIDDLE NAME) ..................................................................................... . ADDRESS ..................................................................................... . CITY/STATE TELEPHONE NUMBER ..................................................................................... . CUSTODIAN OF DOG (LAST, FIRST, MIDDLE NAME) ..................................................................................... . ADDRESS ..................................................................................... . CITY/STATE TELEPHONE NUMBER AFFIDAVIT FOR WARRANT FOR DEPREDATION BY DOG Commonwealth of Virginia VA. CODE §§ 3.2-6543, 3.2-6552 I, the undersigned person, state under oath that 1. Based upon the facts below, I believe that the dog noted below is a livestock killer or has committed acts of depredation on livestock or poultry. I also believe that ........................................................................\ .................................... ............................................ is (are) the owner(s) of the dog. If the dog is in the custody of someone other than the owner, th e facts below name the custodian and the facts to support my be lief that such person is the custodian of such dog. ........................................................................\ ...............................................................................................................................\ ..................................... [ ] Continued on attached sheet. 2. The description of the dog is as follows: ........................................................................\ ...............................................................................................................................\ ..................................... 3. The dog is at the following location: ........................................................................\ ...............................................................................................................................\ ..................................... 4. [ ] I have personal knowledge of the facts set forth in this affidavit. [ ] I was advised of the facts set forth in this affidavit, in whole or in part, by another person whose credibility or th e reliability of the information may be determined from the following facts: ........................................................................\ ...............................................................................................................................\ ..................................... [ ] Continued on attached sheet. I request the issuance of a WARRANT – DEPREDATION BY DOG to the owner or owners and the custodian, if any, pursuant to [ ] § 3.2-6552 [ ] ........................................................................\ ................................ ........................................................................\ ........................... . LOCAL ORDINANCE ............................................... ________________________________________________________________ DATE [ ] ANIMAL CONTROL OFFICER [ ] ........................................................................\ .............................................. ........................................................................\ ...............................................................................................................................\ ..................................... TELEPHONE NUMBER PRINT NAMEAGENCY State of ........................................................................\ ........................ [ ] Ci ty [ ] County of ........................................................................\ ............. Acknowledged, subscribed and sworn to before me th is ..................................... day of ................................................................... , 20 ...................... ........................................................................\ ...... ______________________________________________________________ NOTARY REGISTRATION NUMBER [ ] MAGISTRATE [ ] NOTARY PUBLIC (My commission expires: ........................................ ) FORM DC-397 MASTER 07/16