dog license application - kennel - Gloucester County Virginia

For Office Use Only:DOG LICENSE APPLICATION - KENNELGLOUCESTER COUNTY ORDINANCE AND VIRGINIA STATE LAW REQUIRESALL DOGS 4 MONTHS OF AGE AND OLDER TO BE LICENSED• Veterinarians are required to report all rabies vaccinations to the Treasurer in the monthfollowing the vaccination date.• Beginning 7/1/2008, kennel licenses are sold in blocks of 10 at a cost of $50.00 per block• License must be renewed by January 31 st each year.• License must be attached to the collar at all times.• Rabies certificates must be presented to the Treasurer’s Office.• Failure to purchase a license, failure to put license on dog’s collar or failure to have a validrabies certificate can result in fines up to $500.00 per violation.• You will be given a tag for each rabies certificate presented. Remaining tags may beacquired from the Treasurer’s Office upon presentation of additional rabies certificates.• For additional information, contact Gloucester County Animal Control at (804) 693-5290.Licenses may be purchased in person, by using the drop box in the median of Justice Drive, or by mail at Treasurer, 6489 Main Street,Gloucester Virginia 23061. Make checks payable to Gloucester County. If purchasing a license by drop box or mail, your rabiescertificate will be returned to you with the tag. Replacement tags are available from the Treasurer’s Office for $1.00 each.Owner Name(s):Mailing Address:Home Phone:Physical Address ofKennel:Work/Alternate Phone:(No P.O. Boxes)Number of 10 dog blocks X $50.00 =Signature of ApplicantPLEASE LIST DOGS ON BACK OF APPLICATIONDate

LIST OF DOGS IN KENNEL1)2)Name of Dog Breed/Color SexRabiesExpirationDateVeterinarianon RabiesCertificate3)4)5)6)7)8)9)10)11)12)13)14)15)16)17)18)19)20)For kennels having more than 20 dogs, complete the back of additional forms as needed.