Type Full Name :

Sign With Hand

Last Name

City

{[ADDR]}, Suite 113
{[CITY]}, {[STATE]} {[ZIP]}
(541) 247-3366
{[AWEBSITE]}

Microchip #

If Other Breed, specify

Required Documents

Tail Length

I am unable to locate my current rabies vaccination certificate
I authorize the county to contact my vet for an additional $10 fee *

Vaccination Information

City

Size *

Are you a Senior Citizen or Veteran?

Owner Information

Sex *

Age *

Phone # *

Rabies Vaccination Exempt? *

Color *

{[PNAME]}

Second Phone #

Phone #

State Law requires all dog owners to have a valid Rabies Vaccination Certificate for each of their dogs. Please attach a copy of the certificate using the Select files box below. If you do not have a copy of the Current Rabies Vaccination please complete the next section.

If applying for a Service Dog License, please note an additional application will be sent to you via Email to complete that process.

Address *

Select Payment Type *

Hair Length *

Applicant Signature *

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

I authorize Curry County to obtain a copy of the Rabies Vaccination Certificate from my Veterinarian for an additional $10.00

Last Name *

Address 2

Dog Name *

I acknowledge that all statements made herein are accurate and that this application will not be accepted as submitted until all required documents are remitted, and all applicable fees are paid. I acknowledge that if no payment is made within seventy two (72) hours of this application, it will be deemed null and void, and I will be required to make a new application.

Phone #

Spayed/Neutered? *

Phone #

State

Address

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

Dog licenses are valid for twelve (12) months from the date purchased.

If you are not paying by credit card, note that payment can be made by:
1) Cash or check in person
2) Check in the mail made payable to:

Curry County
94235 Moore Street Suite 113
Gold Beach, OR 97444

Do not mail cash.

License Fee

Vaccination Date *

State

Full Address

New or Renewal?

Dog Information

Name *

Certification

Breed *

Address 2

City *

Service Dog? *

Previous License Number (if known)

Specify Address where BOTH Dog and Owner reside. If address is not available, select 'Non Resident Or Address not Found'. *

Unlicensed dogs that reside in Curry County over 30 days may receive a citation

ZIP