HomeMy WebLinkAboutAnimal license formANIMAL LICENSE FORM
License Tag: Due Date: ___/___/__
NAME
RESIDENCE
RESIDENCE TELEPHONE NO.
Color
Spayed/NeuteredSexD.O.B
Animal TypeAnimal Name
Breed
ANIMAL DESCRIPTION AFFIDAVIT
I certify that I am 60 years of age or older, or
permanently disabled.
Signature Date
By signing this affidavit you are qualified for renewing
your pet's license at half (1/2) the license price. When
submitting payment please indicate by checking the box
below that you have paid at a reduced rate.
CERTIFIED ANIMAL ASSISTANT
SURGICAL STERILIZATION
RABIES VACCINATION
OWNER MUST PROVIDE PROOF OF:
RABIES EXPIRATION DATE
TAG EXPIRATION DATE
RENEWAL TERMS
1 yr. -
2 yr. -
3 yr. -
License Fee: (Amt Due: Annual License Fee)
License Fee: (Amt Due: 2x's Annual License Fee)
License Fee: (Amt Due: 3x's Annual License Fee)
OTHER (Choose all that Apply)
I no longer own this animal.
This animal is now deceased.
Please update my address
I would like to license a new animal..
I would like to request new tags be sent out.
I am renewing at reduced rate.
**** Please Note: License Renewal Term may not extend past your Rabies
Expiration Date.
**** Please Note: A late fee will be assesed if payment is not recieved by the due date.
EMERGENCY TELEPHONE NO.
Looks Most Like
**** Please make the check payable to: City of Iowa City ****
Credit Card Information
Name on card:
Expiration Date :Credit Card Number:
Signature:
Amount Enclosed
License Fee:$___________
Donation Amt:$__________
___/___ (mmyy)_____- ____- ____- ____
ANIMAL LICENSE TAG
1. LICENSE YOUR DOG/CAT
2. HAVE YOUR ANIMAL SPAYED OR NEUTERED
3. VACCINATE YOUR ANIMAL AGAINST RABIES AND OTHER DISEASES
4. KEEP YOUR ANIMAL ON A LEASH
5. TRAIN YOUR DOG NOT TO BARK EXCESSIVELY
6. OBEDIENCE TRAIN YOUR DOG
7. CLEAN UP AFTER YOUR ANIMAL
The animal licensing fees are as follows:
* Altered: $10.00 per year Iowa City and Coralville residence
* Unaltered: $40.00 per year Iowa City residence
* Temporary: $5.00 for young animals under 4 months of age
Annual License Fees
Please contact our office immediately if you have moved or no longer have your animal.
___/___/_____
___/___/_____
Dominant Secondary Third
M / F Yes / No
Cat / Dog
Please Check One: (Apply for New License)______ (Renew Existing License)______