Pet License Application

City Council:
Mayor Tracy Tollefson
Dave Owings
Kimberly Savageau
Justin Schreiber
Patric McCoy

Pet's Name *

Weight *

Rabies Vaccination Expires

Dog

Male Neutered Male Female Spayed Female

Cat

Male Neutered Male Female Spayed Female

Breed *

Color *

Vet Clinic Used

Vaccination Record Presented

Yes No

Please Upload Vaccination Records

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Owner's Name *

Email *

example@example.com

Address (Include Po Box) *

Street Address

Po Box

City State / 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 *

Date

Approved By:

Method of Payment

Cash Check Other

License Number Issued:

FOR OFFICE USE ONLY