City of Des Moines
Pet License Application
Date
Fee
Owner Phone #1
Owner Name
Owner Phone #2
Street Address
City, State, Zip
Des Moines, WA 98198
Mailing Address
City, State, Zip
Des Moines, WA 98198
Pet 1
Pet 2
Dog
Cat
Dog
Cat
Dog
Cat
Name
Breed
Color
Markings
Age
Sex
Male
Female
Male
Female
Male
Female
Altered
Yes
No
Yes
No
Yes
No
Rabies Expiration Date
Check here if claiming special lifetime license status. (Owner is 65 and older)
Altered Cat
Altered Dog
Licensing Fees
$20
$20
Unaltered Cat
Unaltered Dog
$60
$60
Replacement Tag
Lifetime License
$1
Free
For Police Department Use Only
Mail or Drop-off your completed
application. Please DO NOT mail originals.
Remember to attach a copy of the rabies
vaccination & alteration forms.
Sold By
Date Sold
Des Moines Police Department
21900 11th Ave South
Des Moines, WA 98198
Total Amount Received
Tag Number(s) Issued
Pet 1
Pet 2
Pet 3
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