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ti'�r. 4� 7U�2�) 2; 51P`� �;�se i�w � rr� V�, 3'�L�1 F. 2 <br /> �UTE2�TIALLY DANG�ROUS�30G <br /> REQ►i.1EST F+C3R�EAR�NG <br /> {Tn be complet�d�y Ilog Ow�cr} <br /> Date af Requcat; ."�__....._.._�..� �- Aog's Nemc _.....`�"—.T.^__��_ _._........�.._._.__..,.. <br /> .._...3=...`_�"�__...__� .�......�.....��— --___ <br /> Ow��rs Name� �og's Description <br /> L���.f���,t 1�..�. ` .�_�1�,��..._..�_...�......_ _ <br /> (7w�acrAddress: �{,1,.��,��(.5 � � .____ OwnerTcicp�onc: � <br /> 61t3C1 twi ^ J��� � 51•2� <br /> .. �._ _._.���7��..�L'.�..5.�'c�t_�____ _..._....._..__. . _...._ _....... <br /> � Requcst for heari.ng must be made witivn(l4)days of receipt of notice of potcx4tia11y daugero�s dog <br /> dctcrmis�ation. <br /> � Hearing must be 5etd within fourtecn{l�4)ci�ys af zeceipt of this requcst. <br /> • Ttce heating officer shal]issue a decisia�on tha mattcr wit�in t�u(10}days after the hearing. <br /> • l�a tequcst is madc tho owner must still comply with the cequircments of seetiun 34'1.S 1 S LQ E1�lVC 8 TY37CIOGLII� <br /> implanted within 14 days of rcccipt of thc uoticc of po#cntially dangcrnus dog. <br /> I hercby zcquest a hcanng to determine tho validity of the poientialty daagezous dog decleration r�gazding said dog. <br /> .�-,-'" � <br /> (Si�n of tr) <br /> FOR UF�ICE iISE UNL�':Rccaivcd by: Uatc, SCR# <br /> Datc of Service: <br />