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POTENTIALLY DANGEROUS DO+G <br /> REQUEST FOR HEARING <br /> (Ta be completed by Dog Owner) <br /> , __. ._.__ ______.. —.� <br /> — ----- <br /> ._.___._.__�____ _._�_ __.....r.�_.._..�.�__ —� <br /> Date of Request:x. ., Dog's Name � , <br /> , <br /> ` �� -_��'� �....�`...��e._ �_ __._---�_._� �_- ____ --_�` ���`� ` �.�` ' .--...____. _. <br /> (?Kmers Nam�;_.;� � Dog's Doscription - __._ �..��..r�, <br /> j , t , _ ,' � �- t '� +�.. � � � k. � <br /> � l�'�%: • �--� ) ; . `a t€�-., ,P�� ' � � � � �a � '� � 1, �ti�" <br /> � <br /> � . __. .� ._ ____�-..—..�..___________�__.�___�____.�........�.,,.__. �_._.__e,,.�____.._ .... .......,..�, <br /> �Owner Address: Owner Telephone: � <br /> � . <br /> j ,W` ��.: , �'' '�'��,i�"` ,�. � -� .�� �j .� � � . ... � � 1 <br /> , t <br /> ._ � � ; f. ....� <br /> ,y, � <br /> : �. - ,.� t �` ,.a,, }. ' s <br /> �...�.....�.:�..�._..._...�..:; � . ' � .� .. ..3 ' . � ........ <br /> µ ......_. ...�__.......... �. _..._.. __ ..._........,.,,____m.............._..._ <br /> �"���� � � :� �� ..._� �} �'..;� : <br /> ,. ,� ` <br /> � Request for hearing must be made within(14)days of receipt af notice of potentially dangeraus dog <br /> determination. <br /> • Hearing must be held within fourteen(14)days of receipt of this request. <br /> ■ The heazing o�cer shall issue a decision on the matter within ten(10)days after the hearing. <br /> � If a request is made the owner must still comply with the requirements af section 347.515 to have a microchip <br /> implanted within 14 days of receipt of the notice of potentially dangerous dog. <br /> I hereby request a hearing to deternune the validity of the potentially dangerous dog declaration regarding said dog. <br /> �,..� 4 ��� t�,x�� �J '� .`i.,.l ti <br /> _t� . � � <br /> (Signature of Ow�ur) �—` <br /> FOR 4FFICE IISE ONLY: Received by: Date: � �� r� � ICR#�G U O (��� <br /> Date of Service: <br />