Fillable Name Address Phone (City of Cosmopolis)

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Name Address Phone (City of Cosmopolis)

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The Name Address Phone (City of Cosmopolis) form is 1 page long and contains:

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  • 4 check-boxes
  • 14 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Cosmopolis

BROWSE CITY OF COSMOPOLIS (WA) FORMS

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Owner
Name
Address
Phone
Animal Dog Cat
Name
Breed
Color/Markings
Animal Age
Male Female
Altered Unaltered
Does animal have current rabies vaccination?
Yes No
As owner of the above listed animal, I hereby certify that the information provided is true
and correct. I understand that I must maintain current rabies vaccinations on my animal
and may be required to surrender proof of such vaccination and/or treatment records
to the City at any time. I will update the City with my current address and phone number
should it change at any time during the license period. This license may not be transferred
from one owner to another or from one animal to another.
OWNER SIGNATURE DATE
ANIMAL LICENSE (to be completed by City Staff)
License # Total Fees
Issue Date
Clerk/Deputy Clerk
PO Box 2007, 1300 First St.
Cosmopolis, WA 98536
(360) 532-9230 Phone (360) 532-9215 Fax
www.cosmopoliswa.gov
ANIMAL LICENSE APPLICATION
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Name Address Phone (City of Cosmopolis)

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Completed 21 January 2021

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