ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address): TELEPHONE NO.: FOR COURT USE ONLY ATTORNEY FOR (Name): COURT NAME: STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITIONER: RESPONDENT: CASE NUMBER: PETITION TO DETERMINE IF DOG IS Potentially Dangerous Vicious PETITION REFERRED TO ADMINISTRATIVE AGENCY FOR HEARING 1. Petitioner (name): (representative capacity, if any): DEPUTY CLERK DATE requests a hearing under Food and Agricultural Code section 31601 et seq. to declare a dog to be potentially dangerous or vicious. 2. Respondent (name): (address): is the owner or keeper of the following dog (briefly describe dog and give license number, if available): 3. 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. 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 required a 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. b. c. 5. 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: The dog was seized under Penal Code section 599aa and the owner or keeper was convicted under section a. 597.5(a). b. The dog, unprovoked, in an aggressive manner, inflicted severe injury or killed a human being. c. The dog was previously determined to be and is currently designated as a potentially dangerous dog. After its owner or keeper was notified of this determination, the dog continued the behavior described in Food and Agricultural Code section 31602 or the owner or keeper maintained the dog in violation of Food and Agricultural Code sections 31641, 31642, or 31643. (Continued on reverse) Form Approved by the Judicial Council of California MC-600 [New July 1, 1990] PETITION TO DETERMINE IF DOG IS POTENTIALLY DANGEROUS OR VICIOUS Food & Agricultural Code, § 31601 et seq. (Menacing Dog) 2001 © American LegalNet, Inc. PETITIONER: CASE NUMBER: RESPONDENT: 6. This petition is supported by the following (attach a copy of each document checked): a. Declaration of (name): , law enforcement officer. animal control officer The declaration was made after an investigation and determination that probable cause exists to believe that the dog is potentially dangerous or vicious. b. A written and verified complaint signed by a member of the public (name): c. An incident report prepared by (name): d. Affidavit of a witness to the incident (name): e. Other (specify): 7. Number of pages attached (specify): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. This declaration is made on information and belief. Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (TYPE OR PRINT NAME) MC-600 (New July 1, 1990] (SIGNATURE OF PETITIONER) PETITION TO DETERMINE IF DOG IS POTENTIALLY DANGEROUS OR VICIOUS Page two ( Menacing Dog ) 2001 © American LegalNet, Inc.