Form Approved for Optional Use Judicial Council of California MD-100 [Rev. September 1, 2018]PETITION TO DETERMINE IF DOG IS POTENTIALLY DANGEROUS OR VICIOUS (Menacing Dog)Food & Agricultural Code, 247 31601 et seq.Page 1 of 2 ATTORNEY OR PARTY WITHOUT ATTORNEYSTATE BAR NUMBER:NAME:FIRM NAME:STREET ADDRESS:CITY:STATE:ZIP CODE:TELEPHONE NO.:FAX NO.:E-MAIL ADDRESS:ATTORNEY FOR (name): SUPERIOR COURT OF CALIFORNIA, COUNTY OFSTREET ADDRESS:MAILING ADDRESS:CITY AND ZIP CODE:BRANCH NAME: PETITIONER:RESPONDENT: FOR COURT USE ONLY CASE NUMBER:MD-100 DATEDEPUTY CLERKPETITION REFERRED TO ADMINISTRATIVE AGENCYFOR HEARING PETITION TO DETERMINE IF DOG IS Potentially Dangerous Vicious1.Petitioner (name):(representative capacity, if any):requests a hearing under Food and Agricultural Code section 31601 et seq. to declare a dog to be potentially dangerous orvicious.An animal control officer or a law enforcement officer has investigated and determined that probable cause exists to believe that the dog is potentially dangerous or vicious.4.b.(Continued on reverse)c.5.2.3.Respondent (name):(address):is the owner or keeper of the following dog (briefly describe dog and give license number, if available):Potentially dangerous dog Petitioner requests that the dog be declared to be "potentially dangerous" for the following reasons: a. The dog, unprovoked, has on two separate occasions within the prior 36-month period engaged in behavior that requireda defensive action by a person to prevent bodily injury when the person and the dog were off the property of the owner or keeper of the dog. The dog, unprovoked, bit a person causing a less severe injury than described in item 5b. The dog, unprovoked, on two separate occasions within the prior 36-month period, killed, seriously bit, inflicted injury, or otherwise caused injury attacking a domestic animal off the property of the owner or keeper of the dog.Vicious dog Petitioner requests that the dog be declared to be "vicious" for the following reasons: a. The dog, unprovoked, in an aggressive manner, inflicted severe injury or killed a human being.The dog was previously determined to be and is currently designated as a potentially dangerous dog. After its owner orkeeper was notified of this determination, the dog continued the behavior described in Food and Agricultural Code section31602 or the owner or keeper maintained the dog in violation of Food and Agricultural Code sections 31641, 31642, or31643. b. American LegalNet, Inc. MD-100 [Rev. September 1, 2018Page 2 of 2PETITION TO DETERMINE IF DOG IS POTENTIALLY DANGEROUS OR VICIOUS (Menacing Dog)MD-100 PETITIONER:RESPONDENT: CASE NUMBER: 6.This petition is supported by the following (attach a copy of each document checked):The declaration was made after an investigation and determination that probable cause exists to believe that the dog is potentially dangerous or vicious.I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. (SIGNATURE OF PETITIONER)(name):A written and verified complaint signed by a member of the public b.Number of pages attached (specify):Date: (TYPE OR PRINT NAME)7. a.(name):Declaration of animal control officer law enforcement officer. (name):An incident report prepared by c.(name):Affidavit of a witness to the incident d.(specify):Other e.This declaration is made on information and belief. American LegalNet, Inc.