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Here is the text we could read:

ATTORNEY OR PARTY WITHOUT ATTORNEY

STATE BAR NUMBER:

FOR COURT USE ONLY

MD-100

STATE:

FAX NO.:

ZIP CODE:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:

NAME:

FIRM NAME:

STREET ADDRESS:

CITY:

TELEPHONE NO.:

E-MAIL ADDRESS:

ATTORNEY FOR (name):

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PETITIONER:

RESPONDENT:

PETITION TO DETERMINE IF DOG IS
Vicious

Potentially Dangerous

CASE NUMBER:

PETITION REFERRED TO ADMINISTRATIVE AGENCY
FOR HEARING

DATE

DEPUTY CLERK

requests a hearing under Food and Agricultural Code section 31601 et seq. to declare a dog to be potentially dangerous or
vicious.

1. Petitioner (name):

(representative capacity, if any):

Respondent (name):

(address):

is the owner or keeper of the following dog (briefly describe dog and give license number, if available):

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.

Potentially dangerous dog Petitioner requests that the dog be declared to be "potentially dangerous" for the following
reasons:

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.

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, 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 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.

Form Approved for Optional Use
Judicial Council of California
MD-100 [Rev. September 1, 2018]

(Continued on reverse)

PETITION TO DETERMINE IF DOG IS
POTENTIALLY DANGEROUS OR VICIOUS
(Menacing Dog)

Page 1 of 2

Food & Agricultural Code, § 31601 et seq.

PETITIONER:

RESPONDENT:

CASE NUMBER:

MD-100

6. This petition is supported by the following (attach a copy of each document checked):

Declaration of

(name):

animal control officer

law enforcement officer.

The declaration was made after an investigation and determination that probable cause exists to believe that the dog is
potentially dangerous or vicious.

A written and verified complaint signed by a member of the public

(name):

An incident report prepared by

(name):

Affidavit of a witness to the incident

(name):

Other

(specify):

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)

(SIGNATURE OF PETITIONER)

MD-100 [Rev. September 1, 2018

Page 2 of 2

PETITION TO DETERMINE IF DOG IS
POTENTIALLY DANGEROUS OR VICIOUS
(Menacing Dog)

Petition to Determine If Dog Is Potentially Dangerous or Vicious

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 2
Fields(s): 54
Average fields per page: 27
Reading Level: Grade 9
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

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topmost_subform_page_p_caption_atty_party_info_name was topmostSubform[0].Page1[0].p1Caption[0].AttyPartyInfo[0].Name[0] (0.42 conf)
topmost_subform_page_p_caption_atty_party_info_firm was topmostSubform[0].Page1[0].p1Caption[0].AttyPartyInfo[0].AttyFirm[0] (0.42 conf)
topmost_subform_page_p_caption_atty_party_info_street was topmostSubform[0].Page1[0].p1Caption[0].AttyPartyInfo[0].Street[0] (0.42 conf)
topmost_subform_page_p_caption_atty_party_info_city was topmostSubform[0].Page1[0].p1Caption[0].AttyPartyInfo[0].City[0] (0.42 conf)
topmost_subform_page_p_caption_atty_party_info_state was topmostSubform[0].Page1[0].p1Caption[0].AttyPartyInfo[0].State[0] (0.42 conf)
topmost_subform_page_p_caption_atty_party_info_zip was topmostSubform[0].Page1[0].p1Caption[0].AttyPartyInfo[0].Zip[0] (0.42 conf)
topmost_subform_page_p_caption_atty_party_info_phone was topmostSubform[0].Page1[0].p1Caption[0].AttyPartyInfo[0].Phone[0] (0.42 conf)
topmost_subform_page_p_caption_atty_party_info_fax was topmostSubform[0].Page1[0].p1Caption[0].AttyPartyInfo[0].Fax[0] (0.42 conf)
topmost_subform_page_p_caption_atty_party_info_email was topmostSubform[0].Page1[0].p1Caption[0].AttyPartyInfo[0].Email[0] (0.42 conf)
topmost_subform_page_p_caption_atty_party_info was topmostSubform[0].Page1[0].p1Caption[0].AttyPartyInfo[0].AttyFor[0] (0.42 conf)
page_caption_court_info_county was topmostSubform[0].Page1[0].p1Caption[0].CourtInfo[0].CrtCounty[0] (0.39 conf)
page_caption_court_info_street was topmostSubform[0].Page1[0].p1Caption[0].CourtInfo[0].CrtStreet[0] (0.39 conf)
page_caption_court_info_mailing was topmostSubform[0].Page1[0].p1Caption[0].CourtInfo[0].CrtMailingAdd[0] (0.43 conf)
topmost_subform_page_p_caption_court_info_crt_city_zip was topmostSubform[0].Page1[0].p1Caption[0].CourtInfo[0].CrtCityZip[0] (0.34 conf)
page_caption_court_info_branch was topmostSubform[0].Page1[0].p1Caption[0].CourtInfo[0].CrtBranch[0] (0.39 conf)
topmost_page_title_party_name__1 was topmostSubform[0].Page1[0].p1Caption[0].TitlePartyName[0].Party1[0] (0.37 conf)
topmost_page_title_party_name__2 was topmostSubform[0].Page1[0].p1Caption[0].TitlePartyName[0].Party2[0] (0.37 conf)
topmost_subform_page_p_caption_case_number was topmostSubform[0].Page1[0].p1Caption[0].CaseNumber[0].CaseNumber[0] (0.38 conf)
topmost_subform_page_p_caption_referral_info_sf_ref_date was topmostSubform[0].Page1[0].p1Caption[0].ReferralInfo_sf[0].RefDate[0] (0.42 conf)
page_p_info_ref_clerk was topmostSubform[0].Page1[0].p1Caption[0].ReferralInfo_sf[0].RefDeputyClerk[0] (0.38 conf)
topmost_subform_page_p_caption_form_title_area_bad_dog_cb__1 was topmostSubform[0].Page1[0].p1Caption[0].FormTitle[0].#area[0].Bad_dog_cb[0] (0.41 conf)
topmost_subform_page_p_caption_form_title_area_bad_dog_cb__2 was topmostSubform[0].Page1[0].p1Caption[0].FormTitle[0].#area[1].Bad_dog_cb[1] (0.41 conf)
topmost_subform_page_party_ft__1 was topmostSubform[0].Page1[0].Party1_ft[0] (0.38 conf)
topmost_subform_page_party_rep__1 was topmostSubform[0].Page1[0].PartyRep[0] (0.41 conf)
topmost_subform_page_party_ft__2 was topmostSubform[0].Page1[0].Party2_ft[0] (0.38 conf)
topmost_subform_page_resp_add was topmostSubform[0].Page1[0].RespAdd[0] (0.37 conf)
topmost_subform_page_dog_desc was topmostSubform[0].Page1[0].DogDesc[0] (0.35 conf)
topmost_subform_page_pot_dangerous was topmostSubform[0].Page1[0].PotDangerous[0] (0.35 conf)
topmost_subform_page_checkbox__1 was topmostSubform[0].Page1[0].Checkbox[0] (0.38 conf)
topmost_subform_page_checkbox__2 was topmostSubform[0].Page1[0].Checkbox[1] (0.38 conf)
topmost_subform_page_checkbox__3 was topmostSubform[0].Page1[0].Checkbox[2] (0.38 conf)
topmost_subform_page_vicious was topmostSubform[0].Page1[0].Vicious[0] (0.38 conf)
topmost_subform_page_area_checkbox was topmostSubform[0].Page1[0].#area[0].#area[1].Checkbox[3] (0.38 conf)
topmost_subform_page_checkbox__4 was topmostSubform[0].Page1[0].Checkbox[4] (0.38 conf)
topmost_subform_page_px_caption_title_party_name__1 was topmostSubform[0].Page2[0].pxCaption[0].TitlePartyName[0].Party1[0] (0.37 conf)
topmost_subform_page_px_caption_title_party_name__2 was topmostSubform[0].Page2[0].pxCaption[0].TitlePartyName[0].Party2[0] (0.37 conf)
topmost_subform_page_px_caption_case_number was topmostSubform[0].Page2[0].pxCaption[0].CaseNumber[0].CaseNumber[0] (0.38 conf)
topmost_page_complaint_name was topmostSubform[0].Page2[0].PubComplaintName[0] (0.35 conf)
topmost_subform_page_pub_complaint was topmostSubform[0].Page2[0].PubComplaint[0] (0.38 conf)
topmost_subform_page_pp_attached was topmostSubform[0].Page2[0].PPAttached[0] (0.44 conf)
topmost_subform_page_sig_date was topmostSubform[0].Page2[0].sigDate[0] (0.40 conf)
topmost_subform_page_tex was topmostSubform[0].Page2[0].TEXT\.0\.3\.1\.5\.4\.0\.7\.2\.2\.1\.1\.1[0] (0.41 conf)
topmost_subform_page_party_rep__2 was topmostSubform[0].Page2[0].PartyRep[0] (0.41 conf)
topmost_subform_page_checkbox__5 was topmostSubform[0].Page2[0].Checkbox[0] (0.38 conf)
topmost_subform_page_checkbox__6 was topmostSubform[0].Page2[0].Checkbox[1] (0.38 conf)
topmost_subform_page_checkbox__7 was topmostSubform[0].Page2[0].Checkbox[2] (0.38 conf)
topmost_page_inc_report_name was topmostSubform[0].Page2[0].IncReportName[0] (0.34 conf)
topmost_page_inc_report was topmostSubform[0].Page2[0].IncReport[0] (0.36 conf)
page_wit_affidavit_name__1 was topmostSubform[0].Page2[0].WitAffidavitName[0] (0.39 conf)
topmost_page_wit_affidavit__1 was topmostSubform[0].Page2[0].WitAffidavit[0] (0.39 conf)
page_wit_affidavit_name__2 was topmostSubform[0].Page2[0].WitAffidavitName[1] (0.39 conf)
topmost_page_wit_affidavit__2 was topmostSubform[0].Page2[0].WitAffidavit[1] (0.39 conf)
topmost_page_wit_affidavit__3 was topmostSubform[0].Page2[0].WitAffidavit[2] (0.39 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

topmost_subform_page_p_caption_atty_party_info_bar
topmost_subform_page_p_caption_atty_party_info_name
topmost_subform_page_p_caption_atty_party_info_firm
topmost_subform_page_p_caption_atty_party_info_street
topmost_subform_page_p_caption_atty_party_info_city
topmost_subform_page_p_caption_atty_party_info_state
topmost_subform_page_p_caption_atty_party_info_zip
topmost_subform_page_p_caption_atty_party_info_phone
topmost_subform_page_p_caption_atty_party_info_fax
topmost_subform_page_p_caption_atty_party_info_email
topmost_subform_page_p_caption_atty_party_info
topmost_subform_page_p_caption_court_info_crt_city_zip

Suggested Screen 1:

page_caption_court_info_county
page_caption_court_info_street
page_caption_court_info_mailing
page_caption_court_info_branch

Suggested Screen 2:

page_p_info_ref_clerk

Suggested Screen 3:

topmost_subform_page_p_caption_case_number
topmost_subform_page_p_caption_referral_info_sf_ref_date
topmost_subform_page_p_caption_form_title_area_bad_dog_cb__1
topmost_subform_page_p_caption_form_title_area_bad_dog_cb__2
topmost_subform_page_dog_desc
topmost_subform_page_px_caption_title_party_name__1
topmost_subform_page_px_caption_title_party_name__2
topmost_subform_page_px_caption_case_number

Suggested Screen 4:

topmost_subform_page_party_ft__1
topmost_subform_page_party_rep__1
topmost_subform_page_party_ft__2
topmost_subform_page_pub_complaint
topmost_subform_page_sig_date
topmost_subform_page_party_rep__2

Suggested Screen 5:

topmost_subform_page_resp_add
topmost_subform_page_pot_dangerous
topmost_subform_page_checkbox__1
topmost_subform_page_checkbox__2
topmost_subform_page_checkbox__3
topmost_subform_page_vicious
topmost_subform_page_area_checkbox
topmost_subform_page_checkbox__4
topmost_subform_page_pp_attached
topmost_subform_page_tex
topmost_subform_page_checkbox__5
topmost_subform_page_checkbox__6
topmost_subform_page_checkbox__7

Suggested Screen 6:

topmost_page_complaint_name
topmost_page_inc_report_name
topmost_page_inc_report

Suggested Screen 7:

topmost_page_title_party_name__1
topmost_page_title_party_name__2
page_wit_affidavit_name__1
topmost_page_wit_affidavit__1
page_wit_affidavit_name__2
topmost_page_wit_affidavit__2
topmost_page_wit_affidavit__3

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Petition to Determine If Dog Is Potentially Dangerous or Vicious

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02