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FEES: Sterilized Dog 7.50 Non-Sterilized 25.00 Senior Citizen Sterilized Dog 5.00
Duplicate 2.50 Transfer of Ownership 5.00
ENCLOSE COPY OF RABIES & STERILIZATION CERTIFICATE
CHECK PAYABLE TO HUMANE SOCIETY OF SEDONA
OWNERS NAME __________________________________________________
PHYSICAL ADDRESS __________________________________________________
MAILING ADDRESS __________________________________________________
HOME PHONE _____________________ WORK PHONE ___________________
FIRST DOG Renewal [___] New [___] NAME _______________________________
BREED ______________________________ COLOR __________________________________
AGE _______________ SEX ____________ SIZE _________________________________
STERILIZED YES ____________ NO ___________________
SECOND DOG Renewal [___] New [___] NAME _______________________________
BREED ______________________________ COLOR __________________________________
AGE _______________ SEX ____________ SIZE _________________________________
STERILIZED YES ____________ NO ___________________
OFFICE USE ONLY
First Dog Name ____________________________ LICENSE TAG # 02-___________________
Rabies Tag # __________________ Producer ______________ Serial # ____________________
Date Vaccinated _______________________ Expiration Date _____________________________
Second Dog Name __________________________ LICENSE TAG # 02-___________________
Rabies Tag # __________________ Producer ______________ Serial # ____________________
Date Vaccinated _______________________ Expiration Date _____________________________
TOTAL FEES PAID __________ CK# __________ DATE OF PURCHASE ________________
LICENSES ARE VALID FOR ONE YEAR FROM DATE OF PURCHASE
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