Pet Registration Form - City Of Keystone, Iowa

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Pet Registration Form
Due before February 1
New Application
Renewal
Dog
Cat
Date of Application:__________________________________
Name of Owner:_____________________________________
Physical Address:____________________________________
Mailing Address:_____________________________________
____________________________________
Daytime Phone #:____________________________________
Second Daytime Phone #: _____________________________
Name of Pet:________________________________________
Breed of Pet:________________________________________
______Male or ______Female
Color and description of Pet:________________________________________
Age of Pet/Date of Birth_______________________________
A COPY OF THE VACCINATION FORM MUST BE ATTACHED unless
the previous rabies certificate is still current and on file at City Hall, then you do
not need to include another certificate.
Fee is $10.00 per pet f
*
or new and renewal registrations before February 1. Please
make checks payable to: City of Keystone
A $15.00 per month /per animal late fee
will be assessed for all registrations after February
1.
For office Use:
Date of Rabies Expiration:_______________________
Name of Vet:_________________________________
Amount of Fee: $10.00_______
Pd.______________
Tag #_______________________________________
* The tags will be sent to you upon completion of registration form.
* Please complete a separate registration form for each pet.
Additional Comments:
_______________________________________________________________________________
_______________________________________________________________________________

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