Fillable DOG LICENSE APPLICATON (City of Parkville)

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DOG LICENSE APPLICATON (City of Parkville)

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The DOG LICENSE APPLICATON (City of Parkville) form is 1 page long and contains:

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  • 15 check-boxes
  • 32 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Parkville

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DOG LICENSE APPLICATON
OWNER: _________________________________________________________________________________________________
ADDRESS: _______________________________________________________________________________________________
E-MAIL ADDRESS: ________________________________________________________________________________________
PHONES: (home)_____________________________________ (cell/work)_______________________________________
1
ST
DOG:
DOG’S NAME: _______________________________ BREED: _____________________ Micro Chipped? Yes No
Male/Female: ___________________ Neutered/Spayed: _____________ Size: Small Med Large
Color: ______________________________________ Birth Year: ________ Weight: _______________________
Vaccinated against rabies by: ________________________________________________ Expiration Date: _________________
(Veterinarian’s Name)
2
ND
DOG:
DOG’S NAME: _______________________________ BREED: _____________________ Micro Chipped? Yes No
Male/Female: ___________________ Neutered/Spayed: _____________ Size: Small Med Large
Color: ______________________________________ Birth Year: ________ Weight: _______________________
Vaccinated against rabies by: ________________________________________________ Expiration Date: _________________
(Veterinarian’s Name)
3
RD
DOG:
DOG’S NAME: _______________________________ BREED: _____________________ Micro Chipped? Yes No
Male/Female: ___________________ Neutered/Spayed: _____________ Size: Small Med Large
Color: ______________________________________ Birth Year: ________ Weight: _______________________
Vaccinated against rabies by: ________________________________________________ Expiration Date: _________________
(Veterinarian’s Name)
As a responsible pet owner, I agree to comply with all City of Parkville animal regulations as published on
the website at http://parkvillemo.gov,
I understand that this license is good for one year from the date of
registration and must be renewed prior to expiration.
____________________________________________________________ ________________________
Dog Owner’s Signature Date
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
FOR OFFICE USE ONLY:
Fee: $__________ Penalty, if any: $__________ Total Due: $__________ Date: _____________ Dog Tag #: ______
License issued by: __________________ Check: _______ Cash: _______ Credit Card: _______ MO: ____
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DOG LICENSE APPLICATON (City of Parkville)

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Completed 19 January 2021

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