Dog And Cat License Application Form
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1
2DOG AND CAT LICENSE APPLICATION
CITY OF GREELEY
$10.00 – 1YR STERILIZED
1000 TENTH STREET
$15.00 – 2YR STERILIZED
GREELEY COLORADO 80631
$20.00 – 3YR STERILIZED
TELEPHONE
970-350-9722
$15.00 – 1YR NOT STERILIZED
FAX
970-350-9736
$25.00 – 2YR NOT STERILIZED
$30.00 – 3YR NOT STERILIZED
1 Year License______
License Number_________________
Renewal ____ New_____
2 Year License______
Expiration Date__________________
License Year________
3 Year License_______
OWNER:
First Name___________________________________ Last Name__________________________________
Address_______________________________
GREELEY, COLORADO Zip_______________
Home Phone (__________)_________-_____________ Other Phone (__________)_________-__________
PET:
Type_________ (D=Dog, C=Cat, M=Miscellaneous)
Name _____________________________________
Breed______________________________________/______________________________________________
(List abbreviation for up to two (2) breeds visible in animal, most prominent first.)
Color 1_____________________
Color 2 ____________________
Color 3 _______________________
(List color for up to three (3) colors visible in animal, most prominent first)
Sex
________ (M=Male, F=Female)
Neutered
________ (Y=Yes, N=No)
VACCINATED PETS:
Rabies Tag Number___________________ Year_________
Expiration Date _____/_____/_____
Veterinarian: ______________________________________________________________________________
I understand that under Ordinance No. 12, Title 7, of the Greeley City Code, I must keep my pet vaccinated against rabies and submit proof
of vaccination to the Department of finance at the time of submitting application for the license in accordance with City of Greeley
ordinances.
No City license shall be issued if the rabies vaccination period expires more than three (3) months prior to the end of the City License period.
_______________________________________________
_____/_____/_____
(Owners Signature)
(Date)
_____/_____/____ (Date)
________ (Amount) _____________(Cash Receipt #)
_________(Clerk)
If applicable
______________________________________________________
Name of agency issuing license
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