Fillable Animal-tag-application Animal Tag Application Form

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Animal-tag-application Animal Tag Application Form

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Country of origin: US
File type: PDF

U.S.A. forms for City Of Deltona

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CITY OF DELTONA
BUILDING AND ENFORCEMENT SERVICES
2345 Providence Boulevard
Deltona, Florida 32725
Telephone (386) 878-8701 - Fax (386) 789-7237
ANIMAL CONTROL APPLICATION
ANIMAL TAG
TYPE OR PRINT IN INK ONLY
(For office use only)
TAG NUMBER
ANIMAL OWNER INFORMATION
NAME: ________________________ ________________________ Phone #: (_____)______-___________
First Name Last Name
ADDRESS: _______________________________________________________ ____________________
Street Address Zip Code
ANIMAL INFORMATION
TYPE: DOG ( ) CAT ( )
NAME: ______________________________________
BREED: ____________________________________
COLOR: ____________________________________
WEIGHT: ________ LBS.
D. O. B. ________________
GENDER: MALE ( ) FEMALE ( )
SPAYED/NEUTERED: YES ( ) NO ( )
RABIES TAG # _______________________________
DATE VACCINATED: __________/_______/__
______
TAG EXPIRATION DATE: ______/_______/________
VACCINE SERIAL # ___________________________
VET’S NAME/CLINIC OR LICENSE NUMBER:
____________________________________________
VET’S OFFICE PHONE # (_____)______-__________
I am sending attached:
• ________ (Initials) Copy of current Rabies Certificate.
• ________ (Initials) A check or money order in the amount of $ ________ ($5.00 for
spayed/neutered or $10.00 for unaltered) made out to City Of Deltona.
• ________ (Initials) A stamped return envelope for my tags.
**If any of the requested above is missing, the Animal Tag Application will not be processed.
** Complete Animal Tag Applications received will be processed and returned to you in 5 to 10
business days.
ANIMAL TAG FEE:
UNALTERED: $10.00
ALTERED: $5.00
__________________________________________________ ______/______/_____
Date Applicant’s Signature
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Animal-tag-application Animal Tag Application Form

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Completed 12 July 2020

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