Dog License Template, Instructions Page 2
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2County of Fairfax, Virginia
Dog License
For Office Use Only:
Control Number __________
Department of Tax Administration
License Number __________
Expires Dec. 31, _____
12000 Government Cntr Pky, Suite 223, Fairfax, VA 22035
Rabies Expiration Date ___/___/____
(703) 222-8234
Breed Code ____________________
Animal Name ___________________
Fee Enclosed: $ _________
Color Code ____________________
Male
Female
Neu/Spay
Duplicate _______ ___/___/____
Fertile Dog: $10.00
Infertile Dog: $5.00
Original #
Issue Date
Breed _________________________
Kennel
Please include a current certificate of rabies vaccination, and,
Cash
Check
Color _________________________
if applicable, spayed/neutered certification.
Telephone: Work ____-____-______
Home ____-____-______
Last Name
First Name
Middle Initial
Have you ever licensed this dog before
No. and Street, PO Box
in Fairfax County?
Y
N
City, Town, Post Office
State
Zip Code
LICENSE NOT SUBJECT TO EXCHANGE, TRANSFER, OR REDEMPTION.
Valid only if stamped PAID by
County Ordinance (41-2-3H) requires that this receipt be carefully preserved by the
Department of Tax Administration
licensee and presented upon request of the Animal Warden or other officer.
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