Dog License Application printable pdf download

Dog License Application

DOG LICENSE APPLICATION

OWNER NAME

(PLEASE PRINT)

HOME PHONE #

WORK PHONE #

STREET/MAILING ADDRESS

ALTERNATE/EMERGENCY CONTACT NAME

PHONE #

NOTE: IN THE EVENT THAT YOUR ANIMAL SHOULD BE PICKED UP BY THE ANIMAL CONTROL OFFICER, WE ASK THAT YOU ASSIST

THE CITY OF MUKILTEO IN RETURNING YOUR ANIMAL TO YOUR HOME, RATHER THAN TO PAWS, BY PROVIDING THE NAME

OF A NEIGHBOR OR RELATIVE WHO MAY BE ABLE TO HOLD YOUR ANIMAL UNTIL YOU HAVE RETURNED HOME.

DOG INFORMATION

NAME

BREED

COLOR

SEX

IS YOUR DOG SPAYED/NEUTERED?

DATE OF LAST INOCULATION

(MUST SUBMIT PROOF, IF APPLICABLE)

(PROOF OF RABIES INOCULATION REQUIRED)

MICROCHIP BRAND

NAME & PHONE NUMBER OF VETERINARIAN

PHONE NUMBER

I AM THE OWNER OF THE ABOVE LISTED DOG AND TAKE FULL RESPONSIBILITY.

OWNER’S SIGNATURE

DATE

DRIVER’S LICENSE NUMBER

2017 Fee Schedule

Lifetime License

Type of Dog License Purchased

Spayed or Neutered Dog

$40.00

$80.00

Unaltered Dog

*****For Official Use Only*****

Application Received Date:

License # Issued:

Amount of Fee:

Receipt #:

Issued By:

10500 47

Place W • Mukilteo, Washington 98275 • mukilteowa.gov

Dog License Application