New York Codes, Rules and Regulations › Title 19 - DEPARTMENT OF STATE › Chapter XVI - Wild Animals › Part 820 - Required Annual Reporting Of The Presence Of Wild Animals › Section 820.3 - Report form

Current through Register Vol. 46, No. 28, July 10, 2024
The report of the presence of a wild animal shall be made on
				  the following form:
Report No. ______
				  ...........................................................................
Report of the Presence of Wild Animals
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
.
Name:
				  ......................................................................................................
Business Name (if a business):
				  ......................................................................................................
Street Address:
				  ......................................................................................................
City, State and Zip:
				  ......................................................................................................
Telephone Number:
				  ......................................................................................................
Address Where Animal is Located (if different than
				  above):
_______________
_______________
Name of Emergency Contact:
				  ......................................................................................................
Daytime phone number:
				  ......................................................................................................
After-hours phone number:
				  ......................................................................................................
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.
Instructions to the Municipal Clerk:
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 No. ______
				  .......................................................................
Report of the Presence of Wild Animals
List of Animals at this Address
Common name of animal
Number of such animals at this location
Scientific name (genus and species), if known