Application for Kennel License
Name of Applicant
*
First Name
Last Name
Address of Applicant
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number of Applicant
*
-
Area Code
Phone Number
Email of Applicant
*
example@example.com
Is applicant a corporation?
*
Yes
No
If yes, please list State of Incorporation, names and addresses of Officers and Directors or Corporation.
Are the above residents of Wisconsin?
*
Yes
No
Name of person in charge of Kennel
*
First Name
Last Name
Address or person in charge of Kennel
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number or person in charge of Kennel
*
-
Area Code
Phone Number
Number of dogs that can be accommodated
*
Number of dogs to be housed
*
Brief description of facilities provided
*
Is land owned by Applicant
*
Yes
No
If leased, name of Land Owner
First Name
Last Name
If leased, address of Land Owner
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Signature of Applicant
*
Date Signed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
License Fee: $40.00 for first 12 dogs, $3.00 or each dog above 12
Number of Dogs
Should be Empty: