Pet License Application

Pet License Application

FEE: $6.00
Pet's Name*
Weight*
Rabies Vaccination Expires
Dog

MaleNeutered MaleFemaleSpayed Female
Cat

MaleNeutered MaleFemaleSpayed Female
Breed*
Color*
Vet Clinic Used
Vaccination Record Presented

YesNo
Please Upload Vaccination Records

Cancelof
Owner's Name*
Email*
example@example.com
Address (Include Po Box)*

Street Address

Po Box

CityState / Province

Postal / Zip Code
Phone (Home) (Other)
By checking this box I understand that this application is not approved until the pet fee is paid in full and The City of Glyndon approves my application and issues my pet a license number.*

I understand
Signature*

Clear
Date*

MonthDayYear
Date
FOR OFFICE USE ONLY
Approved By:
Method of Payment

CashCheckOther
License Number Issued:
City Hall: 36 3rd Street SE | PO Box 223 | Glyndon, MN 56547 | www.glyndonmn.com | 218-498-2578 | Fax: 218-498-2579
Should be Empty:

FOR OFFICE USE ONLY