I hereby certify that I am the rightful owner/keeper/caretaker/custodian of the animal(s) that is/are the subject of this Domestic Animal Surrender Form, hereinafter referred to as the "Animal". I hereby surrender any and all property rights of the Animal. I certify that no other person or entity has a right of property to the Animal. I understand that by surrendering my property rights to the Animal, the Animal will be transferred into the custody of the City and may be euthanized or transferred into the custody of another person, organization, or entity thereafter. I also hereby certify that the Animal has / has not (choose one below) bitten or scratched a human being or another animal within the past ten (10) days. I understand that once I relinquish the Animal, the Animal will not be available to be returned. I further certify that I have read and understand the terms of this Domestic Animal Surrender Form.