The report of the presence of a wild animal shall be made on the following form:

The information recorded here is essential to emergency services personnel so that they may protect themselves and your neighbors, provide for the safety of your animals, ensure the maximum protection and preservation of your property, and provide you with emergency services without unnecessary delay.

Every person in New York State, who owns, possesses, or harbors a wild animal, as set forth in General Municipal Law, § 209-cc, must file this Report annually, on or before April 1 of each year, with the clerk of the city, village or town (if outside a village) where the animal is kept. A list of the common names of animals to be reported is enclosed with this form. Failure to file as required will subject you to penalties under law.

A separate Report is required to be filed annually for each address where a wild animal is harbored.

Exemptions: Pet dealers, as defined in section 752-a of the General Business Law, zoological and other exhibitors licensed pursuant to 7 USC sections 2133 and 2134, and licensed veterinarians in temporary possession of dangerous dogs, are not required to file this report.

Instructions for completing this form:

1. Please print or type all information, using blue or black ink.

2. Fill in the information requested on this page.

3. On the continuation sheets, fill in the information requested for each type of animal that you possess.

4. Return the completed forms to the City, Town, or Village Clerk of each municipality where the animal or animals are owned, possessed or harbored.

5. File a new report each year, by April 1, for as long as you keep the animal or animals.

6. You are referred to General Municipal Law, § 209-cc for additional information. Copies of this statute and the list of common names of animals to be reported may also be accessed at the Department of State's website, www.dos.state.ny.us.

Address Where Animal is Located (if different than above):

_______________

_______________

Signature and title (if a business) of person completing form:

_______________

_______________

THIS FORM MUST BE FILED WITH YOUR CITY, TOWN (IF THE ANIMAL IS LOCATED OUTSIDE A VILLAGE) OR VILLAGE CLERK. DO NOT FILE THIS FORM WITH THE NYS DEPARTMENT OF STATE.

Forward copies of this Report to:

1. Each NY State Police troop, County Sheriff, and municipal police agency having jurisdiction over the location of the wild animal;

2. The fire chief of each fire department, fire corporation, or fire company serving the location of the wild animal;

3. Each ambulance or emergency medical service department, ambulance corporation, or ambulance or emergency medical service company serving the location of the wild animal.

Report of the Presence of Wild Animals

List of Animals at this Address