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Dog Licensing Worksheet

2. Name*

3. Email Address

5. Address*

7. City*

8. State*

9. Zip Code*

11. Mailing Address

    if different than address above

13. City

14. State

15. Zip Code

17. Phone Number*

19. Second Phone Number

    Providing the Clerks with two phone numbers will help Animal Control contact families whose dogs may be missing. Your phone numbers will not be shared outside of the Clerks office and Animal Control.

21. Payment Preference *

    1. Pay by Phone (Clerk will call you for payment)
    2. Pay by Check (You will mail or drop off a check)

23. Dog Name*

25. Dog Breed*

    If mixed, please provide best guess.

27. Dog Age*

    Please enter year, months.

29. Dog Coloring*

    Please describe the dog's coloring. You may list more than one color.

30. Dog Sex*

    1. Female
    2. Male

31. Spay/Neuter *

    1. Spayed
    2. Neutered
    3. Unaltered

33. Rabies & Spay/Neuter Documentation

    Please attach a copy of the dog's spay/neuter certificate as well as proof of a current rabies vaccination with expiration date. Photos of hard copy certificates or documents are acceptable.

34. Documentation *

    1. I am submitting supplemental documentation by attachment here
    2. I am sending in documentation via mail or drop box

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field