FOR OFFICE USE ONLY
DATE ________________
LICENSE # ____________
CITY OF DULUTH
CITY CLERK’S OFFICE
330 City Hall ! 411 West First Street
Duluth, Minnesota 55802-1189
Phone (218) 730-5500
Fax (218) 730-5923
LICENSE APPLICATION
Type in your information by tabbing through the boxes below. Print, sign and submit all pages to the address above.
GOVERNMENT DATA PRACTICES ACT - CLASSIFICATION WARNING: The data you supply on this form will be used to process the license
you are applying for. You are not legally required to provide this data, but we will not be able to process the license without it. Some of the data
will be classified as public data if and when the license is granted. Private financial information including a tax identification number and social
security number are classified as private data and will be available to governmental personnel and other governmental agencies whose access
is necessary to perform their official duties.
LICENSE FEE
MAXIMUM PET LICENSE = $8.00
LICENSEE NAME/ADDRESS/PHONE:
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_____________________________________________
_____________________________________________
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HOME PHONE: _______________________________
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NUMBER OF DOGS: _______
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NUMBER OF CATS: _______
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LICENSE PERIOD: JANUARY 1 TO DECEMBER 31
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I HEREBY STATE THAT ALL INFORMATION HERE IS TRUE AND CORRECT AND THAT I SHALL COMPLY
WITH ALL PROVISION OF THE ORDINANCES OF THE CITY OF DULUTH AND LAWS OF THE STATE OF
MINNESOTA AND THEIR AMENDMENTS.
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Signature of Applicant
MAILING ADDRESS:
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