City of Helena
316 N Park Avenue, Room 150
Helena MT 59623
(406) 447-8450
Fax (406) 447-8377
citywater@helenamt.gov
CERTIFICATE OF REGISTRATION FOR A
DANGEROUS DOG
$25.00 Annual Fee (Jan. to Dec.)
I ______________________________, of _______________________________, Helena, MT
Type/Print Owner’s Name Street
Address Declare That:
1. I am the owner of a dangerous dog described as:
________________________________ __________ ______________
Dog’s Name/Breed Sex Color
__________________ __________ _________________ ______________
Size – S, M, L Weight Dog License Number Dog Tag Number
2. I securely confine the dog on my property in the following manner (check all that apply):
__ Indoors.
__ In a closed and locked pen or structure with secure sides and a secure top that provide the dog with
protection from the elements. If the bottom of the pen or structure is not secured to the sides, the sides
must be embedded no less than two feet (2’) into the ground.
__ Muzzled and restrained by a substantial leash or chain and under the control of a responsible person.
3. I have the following insurance protection-Must be attached to this application
(check one of the following):
__ A security bond in the amount of at least $50,000.00 issued by:
(A copy of the security bond is attached to this application.)
________________________________ ____________________
Name of Surety Date of Bond
__ Liability insurance (such as homeowner’s insurance). A copy of policy issued by an insurer qualified
under the laws of the state in the amount of at least fifty thousand dollars ($50,000.00), insuring the owner for any
personal injuries inflicted by the dangerous dog . (Ord. 2452, 9-14-1987)
________________________________ ____________________
Name of Insurance Company Policy Number
________________________________ ____________________
Name of Insured Date of Policy
I understand that this Certificate of Registration may be revoked for any violation of the Helena Animal Control
Ordinances. I am aware that providing false information on this document may be punishable under Section 45-7-203,
MCA.
_______________________________
________________ ________________________________
Signature of Applicant Date
Application Reviewed by City Attorney ____
____________________________________ __________________________
Signature Date
