2004 KENNEL LICENSE

 

***ATTENTION KENNEL LICENSE HOLDERS:  FEES:  $50 AND $3 FOR EACH DOG OVER 12 DOGS.  LATE FEE:  $5 FOR EACH DOG.  DUE BEFORE April 1, 2006.  Please pay with cash or a check payable to:  TOWN OF OCONOMOWOC.  DO NOT INCLUDE THIS FEE AS PART OF YOUR TAX CHECK PAYMENT.  PLEASE WRITE A SEPARATE CHECK. 

         NAME OF DOG                                         SEX                                    NEUT/SPAY                          BREED                               COLOR

1._____________________   __________    __________________   __________________   ______________

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11.____________________   __________    __________________   __________________   ______________

12.____________________   __________    __________________   __________________   ______________ 

 

Rabies Vaccination:                         Month              Day                Year

                                                1. _________  ___________ ___________         Expiration Date:  ____________

                                                2. _________  ___________ ___________         Expiration Date:  ____________

                                                3. _________  ___________ ___________         Expiration Date:  ____________

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                                                9. _________  ___________ ___________         Expiration Date:  ____________

                                              10. _________  ___________ ___________         Expiration Date:  ____________

                                              11. _________  ___________ ___________         Expiration Date:  ____________

                                              12. _________  ___________ ___________         Expiration Date:  ____________

 

I, hereby certify the information above is true and correct to the best of my knowledge:

 

_______________________________________                           _____________________________________

               (Signature of Dog Owner)                                                                  (Please print your name here)

 

Street Address:_________________________________________________________________________________

                                            (Street)                    (Town, City, Village)                      (State)                    (Zip)

 

Wisconsin Law requires your dog to be vaccinated for rabies within 30 days after it is 5 months old.  Bring or mail your rabies certificate with your application.  Your certificate will be mailed back to you.  Licenses cannot be issued without a current rabies shot.