Dog Licensing Form
MONO COUNTY
Contact Information
Your Name
First Name
Last Name
Email Address
example@example.com
Contact Number
Format: (000) 000-0000.
Address
Street Address
Mailing Address
City
State / Province
Postal / Zip Code
Dog Information
Dogs Name & Breed
First Name
Breed
Dogs Date of Birth (best guess if unknown)
-
Month
-
Day
Year
Date
What is the dog's gender?
Male
Female
Is the dog Spayed or Neutered?
Yes
No
Does the dog have a microchip?
Yes/No?
Microchip Number
Veterinarian Information (Dr.'s Name) WE CANNOT PROCESS YOUR APPLICATION WITHOUT THIS INFO!
First Name
Last Name
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Licensing Type: We will need proof of Spay/Neuter & a Valid Rabies Certificate
Dog S/N (1 Year) $15.00
Dog S/N (2 Year) $30.00
Dog S/N (3 Year) $45.00
Dog Intact (1 Year) $33.00
Dog Intact (2 Year) $66.00
Dog Intact (3 Year) $99.00
ID/Tag Size
Small (0.88 inches)
Large (1.18 inches)
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Payment Options
Payment Type
Visa
Visa Debit
Mastercard
American Express
Discover
Other
If other, please specify:
Credit Card Information
Card Holder Name
Credit Card Number:
CVC
Expiration Date
Postal / Zip Code
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Interested in Making a Donation?
I want to help more pets in my community find a safe andhappy home. I wish to donate:
$5.00
$10.00
$25.00
Other
If other, please specify:
Signature
Who Do I Make Checks Out To?
Mono County Animal Services PO Box 263 Bridgeport CA 93517
The personal information contained on this form is collected under the Freedom of Information and Protection of Privacy Act and will be used only for the purpose of responding to your request.
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