121 Police Report 2008 6/26/2808 11:31 4135871137
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NORTHAMPTON fr FD
Northampton Police Department
29 Center Street
Northampton MA 01060.3090
(413) 587-1105 FAX (413) 587-1137
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FROM:
Name I—Ynn�
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JUN 2 6 2008
NORTHAMPTON BOARD OF HEALTH
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06/26/2000 11:31 4135871137
NUMIWWWY UN NH rU
NORTHAMPTON ANIMAL CONTROL
ANIMAL BITE INVESTIGATION BEN
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S• CIES: DOG CAT OTHI1
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EE OF BI
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ATE/TIME OF INCID
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/ -15_- / 7 pm
RkrKrEU nIE WOUNls
INNERS NAME h A1lStt
DDRESS
YPE OF
rNUC. UZ G.,
BR '
N .i
COLOR
LIC#
RABIES EXI\ A
SITE OF BITE'
SEVERITY
DA I .. OF IN
NAME
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OIYE#
ONE# 1-97$ - 5r$ - .x`'15`":
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VET. nine( �foutn AGE
.IC#(YR RABIES AC IMP DATE___64,2, .
tTI I IN BY ANOTHER ANIMAL IN THE PAST 12 MONTHS? YES YES K NOWN-
)ETAILS OF BITE,TREATMENT,QUARANTINE
OAR BREED
4
Nlt1
SPECIES
3EH VIOR AND COND
WAS ANIMAL D
ROW? N
DATE
YES N
DEATH KILLED METHOD
TIME OF DEATH
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WA:.BII'EISCRATCHPROVOKED? YES NO UNKNOWN WAS VICTIM TREATEDg;YES 0
CAA ER? OTHER? DRS NAME ADDRESS
PERSONAL PHYSICIAN br Qi re n ADDRESS Jaite r PHONE I
DESCRIBE TREATMENT: Flpp,o,,, l,4 ,nc res T�� ^"'« "
(POLICE REPORT# PHOTOS? YES + FILED AT NPD?
!WAS ANIMAL TESTED? YES RESULTS: S' NEGATIVE OTHER
(QUARANTINE ORDERD BY ACO? YES( ARY
(DATE REPORTED TO DOH:
FINAL _br:=
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lb 3)
x 1 honcionzielee(pupentiney 6 leptospiroseo ' N.B.;
2 parvo-gefnacevoerd - 7 para.-Influenza niet galena voce het buitenland zooder officio&rablescertilkaat
3 pa vo-levend(verzwald) 8 bordeteta , (dierenpaspoort)
4 hondeziekte(vanaf 12 wkn) 5 corona
re r- 5 Ievealekle 10 hondsdotheel(rabies)" y
RI — tµk-�,\n 0.000 �-1 P(1G�1iC0-- aOr� ?
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Date: 90-Of I Time:
Name of Complainant:
Address:
IMap: Parcel:
NATURE OF COMPLAINT.
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Location:
Owner:
Address:
Tel:
I Tel:
Taken by: I Date of Inspection: to-y3O ITime: no
INSPECTOR'S REPORT:
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Action Taken: (�
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Signature
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Date:
I Time:
I Map:
Parcel:
Name of Complainant: ' -‘,...t‘,n 424.1/4\3..„,%.,
Address:
Tel:Lt_'14'
NATURE OF COMPLAINT:
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Location: \K, ' t`A
Owner:
Address:
I Tel:
Taken by:
I Date of Inspection:
I Time:
INSPECTOR'S REPORT: V
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Action Taken: Ce-y
Inspector Signature
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NORTHAMPTON ANIMAL CONTROL
ANIMAL BITE INVESTIGATION
2SON BITTEN/SCRATCHED • NIMAL B- EN
ME' nCL1 Pcl\em S CIES: DOG CAT OTHER
DRESS "-kite S�' B' .D
B 2 EI4 ( QF SCHOOL
T
ZE T rmvoR> T \svH RI\,e.,n
DNE#
E OF BITE ide. knee
VERITY
TE/TIME OF INCIDE (,-asto / 'l Pm
N
COLOR
LIC
RABIES EXP.
SITE OF BITE
SEVENTY
DATE
OWN
ADS ' SS
ONE#
IMESTIC ANIMAL INFO (THAT INFLICTED THE WOUNDS) CRP\r oir-1 z_eb.cr9 izs
/NERSNAME rrc vvw. \ C \\!e{ / ONE #
DRESS U \ n nt,. S35"
PE OF ANIMAL OG AT OTHER BREED
1MIE m�\ V OLOR n mere 'room AGE___
#/YR VET. RABIES VAC EXP DATE/
[TEN BY ANOTHER ANIMAL IN THE PAST 12 MONTHS? YES t
',TAILS OF BITE, TREATMENT, QUARANTINE FROM PAST BITE
SEX: M MTN FF/S
ECIES
;HAVIOR AND COND
AS ANIMAL DE
)W? N
AL INFORMATION(THAT ENFLICTHD WO
YED? YES N
DEATH KILLED METHOD
ME OF DEATH
ECEIVE
NORTHAMPTON BOARD OF HEALTH
DETAILS OF INCIDENT
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l u . u ., •I - to / /. Y • • • •
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AS BITE/SCRATCH PROVOKED? YES NO UNKNOWN WAS VICTIM TREATED
)H ER? OTHER? DRS NAME ADDRESS
?RSONALPHYSICIAN br C;(vOtA r‘ ADDRESS a\le \I\e4
F-SCRIBE TREATMENT: pIPp,H,,,,.„1, \\'• Rwn Tko-ts�wcsz—
RESULTS OF INVESTIA TION
PHOTOS? YES IO FILED AT NPD? YE
RESULTS: P ITIVE NEGATIVE OTHER
)LICE REPORT #
AS ANIMAL TESTED? YES d0
LIARANTINE ORDERD BY ACO? YES
ATE REPORTED TO BOH: PRELIMINARY
PHONE ti
assts
co
Entdatum
Type vaccin. , Stempel/ ha dtel<ening )ccinatie
Fabrikaat en p$tijnurr ,,e. -) dierenart herhalen op/over
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t 5 6 7
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5 6 7 8
9 10
4
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5 6 7 8 .
9 10
1 handenzielete(pupenting) 6 leptospirosen ' N.B.:
2 parvo-geinactiveerd . 7 para-influenza niet geldig voor het buitenland zonder officieel rabiescertificaat
3 parvo-levend(verzwakt) 8 bordetella (dierenpaspoort)
4 hondeziekte (vanaf 12 wkn) 9 corona
5 leverziekte 10 hondsdolheid (rabies)"
""� ":s can c76t.(..0Yn c\ u (3evicech. — 17 c-v Vono.- oDoce. dce endcca-}e &os was)
\ cSiv`a ec c 6100 - w:ach A ce, .cccna on bo
aooto0c €-Q. \ 1
. _ri.ptdjc oc\ *G. s (A _) op-a-0‘)�� . I
61. neir �a_o Ifle,UPX reVGtCC2n A Yc✓N Ra�] t� , i1)p0 is GSl Vacc ,n01�o'I
J
ark Berens, D.V.M. Animal Hospital 185 Locust Street, Northampton,MA 01060
9TE VACCINATED: 07-07-08 REVACCINATION DUE DATE: 07-07-09 TAG 80477-08
---- CLIENT ----
---- PATIENT ----
NAME MILK
SPECIES CANINE
Breed MIX
Sex FEMALE SPAYED
COLOR BROWN
WEIGHT BORN
;BABIES, 18028A, , KILLED,
lave vaccinated this animal in
any' s recommendations for the vaccine
ENS ANIMAL HOSPITAL
LOCUST STREET
THAMPTON, MA 01060
3) 584-9477
/449,4„,..5 .