OWNER NAME:
(PLEASE PRINT)
HOME PHONE #:
WORK PHONE #:
STREET/MAILING ADDRESS
(STREET) (CITY) (ZIP)
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:
SEX:
COLOR:
IS YOUR DOG SPAYED/NEUTERED?:
DATE OF LAST INOCULATION:
(MUST SUBMIT PROOF, IF APPLICABLE)
(PROOF OF RABIES INOCULATION REQUIRED)
MICROCHIP BRAND:
MICROCHIP #:
NAME 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:
FEE SCHEDULE
Type of Dog License Purchased
Lifetime License
Spayed or Neutered Dog
$40.00
Unaltered Dog
$80.00
*****For Official Use Only*****
Application Received Date:
License # Issued:
Amount of Fee:
Issued By:
Receipt #:
10500 47
th
Place W Mukilteo, Washington 98275www.ci.mukilteo.wa.us
(REV 9/19)
DOG LICENSE
APPLICATION
click to sign
signature
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