Type Full Name :
Sign With Hand
Last Name
City
If "Other", specify
Vaccination Information
Microchip #
Size
Owner Information
Sex
Age
Phone #
Rabies Vaccination Exempt?
Color
{[PNAME]}
Phone #
Address
All dogs 6 months of age or older are required by law (Chapter 140. Sec 137, as amended) to be licensed on or before the 31st day of March every year. ALL LICENSE HOLDERS MUST BE 18 YEARS OF AGE OR OLDER.
Hair Length
Applicant Signature
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
https://chesapeake.wv.gov
First Name
Expiration Date
ZIP
First Name
If applicable, provide details of another owner for this dog that resides at the same address.
Veterinarian Information
Requesting RFID Tag?
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 Dog License.
*For service dogs, please contact the City Clerk’s Office.
Phone #
Spayed/Neutered?
Application Type
Vaccination Date
State
Email
Full Address
Dog Information
Animal Clinic/Veterinary Hospital Name
Certification
Breed
Unit/Apt #
Signed under the pains and penalties of Perjury
Email
Specify Address where BOTH Dog and Owner reside