Type Full Name :

Sign With Hand

Last Name

City

If Other Breed, specify

{[CNAME]}
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}

Required Documents *

Vaccination Information

Size *

Owner Information

Sex *

Age *

Phone # *

Rabies Vaccination Exempt? *

Color *

{[PNAME]}

Phone # *

Current rabies certificate
Spayed/Neutered certificate

Address *

Hair Length *

Applicant Signature *

Rabies Tag #

First Name *

Expiration Date *

ZIP

First Name

Is Valid?

If applicable, provide details of another owner for this dog that resides at the same address.

Veterinarian Information

Last Name *

Dog Name *

By submitting this form, I am confirming that all of the information I have entered is accurate, according to the best of my knowledge. I understand that failure to provide correct information will result in revocation of my pet’s license.

Microchip # (if applicable)

Phone #

Spayed/Neutered? *

Application Type *

Note that payment must be received in full before a Dog License and Registration Tags can be issued.

License Fee

Vaccination Date *

State

Email *

Full Address *

Dog Information

Name *

Certification

Breed *

Address 2

Service Dog? *

Prev. Lic. # (If known)

Specify Address where BOTH Dog and Owner reside *