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Dog License Application Form 2010
DISABILITY OR SENIOR CITIZEN FEE
SPAYED
FEMALE
MALE
$6.45
NEUTERED
MALE
FEMALE
$6.45
$4.45
$6.45
SPAYED
FEMALE
$4.45
PLEASE NOTE: IF YOU ARE APPLYING FOR A LICENSE THAT REQUIRES THE DOG OWNER
BE A SENIOR CITIZEN, AGE 65 AND OLDER, OR A PERSON WITH DISABILITY, YOU MUST
PROVIDE PROOF OF AGE OR DISABILITY TO THE COUNTY TREASURER OR AGENT.
OWNER’S NAME
TELEPHONE NO.
OWNER’S DATE OF BIRTH
STREET OR R.D. NO.
CITY
MO.
DAY
YR.
TOWNSHIP/BOROUGH
STATE
ZIP...
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