ANIWAL BITE REPORT LOCAL RABIES CONTROL AUTHORITY STATEMENT FORM PLEASE PRINT CLEARLY Instructions for ‘completing form: ‘This form to be Subniltted by the parson thal waz biilen or scratched, “This allows the local rables control authority to evaluate aid monitor the animal. ll in all blanks, Put unienown if you do not know or iW if doesn't apply. aiding a minor juvenile. Phone: Home __ T~ Naine off 7 Today's “3 Urgent, Gare/Clinic tf Date: 3 troatinunt was Exposed ee Name Belt, whey Parent/Guardlian's Name if pationt is «win Street Address: (10 (Able } eee’ foc. Slate: ‘Where did incident occur: | Date Bite or scratch Occuirs ‘Type of inlury)S Bite C1 Seratch C1 OWier Was Skin Broken: YES C1 NO if Yes: S2¢Puncture _J8'Scrateii 18 | “CAbrasion “EkLaceration strost Address: (USO te Hor / hee? b. L8fSaliva conta. Information Phone: Home information provided. pete 2 32! Anal | species: Boo (Cat C1 Other Greed (Fimown) 2 Owners Name: [Da Street Address: “Ae Let How do you know this is the owner: (We r'ghy oar hee? [This information is accurate to the best of my knowledge. Signature of Person injured or PurenyGuurin: ~ Gly of Frisco, Animal Sarviess, 7200 Stonebrook Pkwy, C2) color Oley. Benee €1.Unknown [1] Unicnown where owner twos Work sco, Texts 75084 (672) 202-6308 6076 Fev O0e/2019 Fax: (972) 2RB Yomn Merde, 2 DI1G Twos 6a fuce : beck gerd af rng heme. wtr Mey 3 dogs. 2) Heard ber king 0 Ye on tere (Cleont gerd sib) on ay fore ily degs uxat Yo Hew feace OA Vie ini Of pu gare? te peque 3 tiga te. pen Maer autivel oe pt bully wete O1 he ole site of wey ferce backs aad : GRoliag. ple ang Aogs aliieted foo hace ee Pt bel/s Leper Ogee ve growl 15, brking bites @ fue feng | g fleaprhag fo eater my ya? (D deer ton herd Di uautes Su PY bel’ began Coting ancl fesrir, al ney [eace Jo Yure pont fon Coal get fu0rr beac? In Jie fence, father Jleel fo Fomee ney hogs however Hen gg /eS8re.. 2 Sruehion @scala teed to Sor groin 7 She bw PA bull ‘hac? ahold of me of my cS, 7 atenptd fo Sree bap macd foe Ser bt my hand sje | Sraes remove, due Ae at “iy Sooo 9 t QF ore ve es tank af Yor horse Jo bent blo | a4 6 anday, calli ag Gil, chs S0ag Shem vdeo boa | sfloet ‘ a | a Hoserletzed low Hf cheugs AF Vi rectmrerd Tom Pose es | | | | | |