Animal License Registration

2. Registration Date*
   Registration Date

3. City License Tag Number

7. Owner Information

9. Name(s)*

11. Address*

13. City*

14. State*

15. Zip Code*

17. Phone Number

18. Email Address

22. Animal Information

24. Name*

25. Age*

    Please use Months or Years with the number provided.

27. Sex*

    1. Male

    1. Female

28. Neutered / Spayed*

    1. Yes

    1. No

30. Breed

31. Color*

33. Veterinary Clinic:

35. Veterinary Phone Number

37. Rabies Vaccination Date:*
    Rabies Vaccination Date:

38. Rabies Tag Number:*

42. Rabies Vaccination Certificate*

    Attach a copy of your most recent rabies vaccination

44. Payment Information

46. Payment Information*

    1. Neutered / Spayed ($10)

    1. Unneutered / Unspayed ($50)

    1. Penalty ($10)

    1. Replacement License Tag ($3)

48. Total Fee:

    ***For payment, please mail, call or stop by City Hall.

52. Receipt Number

Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

* indicates a required field