| COLOR
OF DOG |
SPOTTED
|
WHITE
|
BLACK
|
BROWN
|
OTHER
|
|
|
|
|
|
|
|
|
|
|
REGULAR
|
PERSON
WITH DISABILITY OR SENIOR CITIZEN FEE
|
|
|
MALE
|
NEUTERED
|
FEMALE
|
SPAYED
|
MALE
|
NEUTERED
|
FEMALE
|
SPAYED
|
|
|
|
MALE
|
|
FEMALE
|
|
MALE
|
|
FEMALE
|
|
|
$8.00
|
$6.00
|
$8.00
|
$6.00
|
$6.00
|
$4.00
|
$6.00
|
$4.00
|
|
|
|
|
|
|
|
|
|
|
|
|
ABOVE PRICES INCLUDES $1.00 SERVICE FEE
|
PROOF OF DISABILITY REQUIRED
|
|
|
ALLOWED BY LAW
|
|
|
|
If the license is issued by an agent of
the County Treasurer an additional $.50 may be charged
|
|
|
NOTE IF YOU ARE APPLYING FOR A LICENSE
THAT REQUIRES THE DOG OWNER BE A SENIOR CITIZEN OR A PERSON WITH
DISABILITY, YOU MUST PROVIDE PROOF OF AGE OR DISABILITY TO THE COUNTY
TREASURER
|
|
|
OWNERS
NAME
|
PHONE
NUMBER
|
OWNERS
BIRTH DATE
|
|
|
|
|
|
|
|
STREET
ADDRESS /R.D. #
|
TOWNSHIP/BOROUGH
|
|
|
|
|
|
|
CITY
|
STATE
|
ZIP
CODE
|
|
|
|
|
|
|
|
E-MAIL
ADDRESS:
|
|
|
|
I hereby
verify that I am the owner of the described dog and all information
provided on this application is true and correct. I make this statement
subject to the Criminal
Penalties of 18 Pa. C.S. section 4904 (Relating to unsworn falsification
to authorities.
All dog owners/applicant must sign
DOG OWNER/APPLICANT
|
|
|
|