I hereby certify that I am the rightful owner/keeper/caretaker/custodian of the dog in this Form. I hereby surrender any and all property rights to the animal. I certify that no other person has a right of property to the animal. I understand that by surrendering my property rights to the animal, the animal may be transferred into the custody of an animal shelter. I also hereby certify that the animal has/has no bitten or scratched a human or another animal. 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 form.

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