I■ 03/08/2022 10:21 4024260101 HOLSTEIN VET CLINIC PAGE 01/01
■ 2022 PET LICENSE
'VERIFICATION / APPLICATION FOR CITY OF BLAIR
Ir YOU LIVE IN BLAIR CITY LIMITS AND OWN A DOG(S) AND /OR CAT(S),
j COMPLETE THIS FORM AND RETURN WITH A'CHECK PAYABLE TO'.
CITY OF BLAIR — 218 S. 16T" ST -- BLAIR, NE 68008
YOU MAY LEGALLY OWN A COMBINATION Or FOUR (4) ADULT PETS,
BUT N 'MORETHAN THREE (3) ADULT DOGS OR THREE (3) ADULT CATS PER RESIDENTIAL OR DWELLING UNIT.
*'"*PLEASE READ GAREFULLY***
It shall be unla%
NEW PET LICE
NEW RESID��
Owner Nam
Spouse
Owner Addl
City/State/ I
i
Phone #
iRE RE IRED B LAW TO LICENSE YOUR PETS. THE ITY OF BLAIR RE UIRES P OOF OF RABIES VAGCINA710N.
Failure to do so Is a viol�tlon of Clty Ordinances 6,�.03 and carries a penalty of 8 fine up Yo $150,00 per pet.
'• PET LICENSE RENEWALS RE DUE BY 3 15 2021.
The city shall recognize a microchip ID number as the license number.
for a'ny dog or cat to wear any license or other city ID other than that issued by the City of Blair for such dog or cat.
NG Must be licensed Within 10 days of ownership (OR) at 6 months of age if puppy or kitten
TO BLAIR Must register pets within 1.0 days of residency
' 1 ,
i
Pet Name: assiUS
Age: 7Y Sax: ' Neutered Male
DOB: 10-16-
BKeed: Pug Mix
I
Microchip # 9 85112001529340
PLEASE INCLI ,YE CITYTAG NUMBEF
RABIES VAC4, iNATI,0N DONE ON
aw,
Melissa Inget
Justin
1137 Grant Street
Blair, NE 68008
402-995-9465
Fawn/Blk
Rabies Tag # 18925
IF THIS IS A RENEWAL (IF AVAILABLE): #
02-24-21
1 YEAR
Rabies Desc ption: I
3 YEAR
i
Hol m . Veterinary Clinic
Dr. Lis , Schrum DVM ; Dr. Kr/sta Holstein ,DVM
718 830uth 1911 Street Blair, NE 68008
46 2-426-7387 402-426-0101 Fax
holsteinclinicOgmail.com
LICE SN E FEES
Intact
Dog or Cat: $16.00
/ ered
D4Z cat: $
Replacement Tay
$5.00
Total $ `\
,M
PETS THAT RA E ON T_ E ACTI V VE oTgNTIALLY DI�NGEROU OR
DANGEROUS OG LIST NEED TO EGIST�R DIRECTLYAT CITY HALL.
CITY OF BLAIR - 2021 PET LICENSE APPLICATION wMl
If you live in Blair City limits and own a dog(s) and/or cat(s), complete this form and return with check made payable to:
City of Blair a 218 S 16th St • Blair, NE 68008
You may legally own a combination of four (4) adult pets, but no more than three (3) adult dogs
or three (3) adult cats per residential or dwelling unit.
LICENSE RENEWALS ARE DUE: March 15, 2021
Owner Name: CU9T 6600
Owner Address: 1'2 0 fASt• JZIJLG1U-� -DR.
City/State/Zip: Blair, NE 68008
Phone # 402 L 50 OS 113
LICENSE FEES: Dog or Cat: $16.00
Altered Do or Cat• $11 00
***PLEASE READ CAREFULLY***
YOU ARE REQUIRED BY LAW TO LICENSE YOUR PETS.
Failure to do so is a violation of City ordinances 6.103 and carries
a penalty of a fine up to $150.00 per pet.
PET LICENSES RENEWALS ARE DUE BY 3/1512021. The City shall
recognize a microchip Identification number as the license number. It
shall be unlawful for any dog or cat to wear any license or other city
Identification other than that Issued by the City of Blair for such dog or
cat. The City of Blair requires proof of rabies vaccination.
9
Replacement Fee for Lost Tag: $5.00
Included is a State Fee of $1.25 being collected to fund the Nebraska Dog & Cat Operator Inspection Program N I A-'
PET # 1 Zr Dog ❑ Cat 4�:(Spaye /N utered License Fee
Pet Name _ Birthdate 5/2 20 Sex M
Color t� A k P�r2n-' Breed** Replacement $
Declared Dangerous or Potentially Dangerous Dog: ❑ Y k�'N to
MICROCHIP # 2 0 (If applicable) S BTOTAL: $
RABIES VACCINATION DATE: I kZ412 n (3 yr), (1 yr) q z City Tag # I
PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Birthdate Sex
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: (3 yr)
PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Birthdate Sex
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y
MICROCHIP # (If applicable)
RABIES VACCINATION DATE: (3 yr) _
W
❑N
License Fee $
Replacement $ * *
SUBTOTAL: $
(1 yr) City Tag #
License Fee $
Replacement $
SUBTOTAL: $
(1 yr) City Tag #
*PLEASE INCLUDE THE CITY TAG NUMBER IF THIS IS A RENEWAL
** (This fee is due along with License Fee if requesting at the time of license renewal.)
**
Do Not Send Cash by Mail TOTAL ENCLOSED $ ®�
If you have questions, please contact Blair Police Department at (402) 426-4747
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (Maroh 15late fee date not applicable I&newpets/newresiden(s)
Newly Acguired Pets: New Residents to Blair:
■ Must be I'loensed within 10 days of ownership ■ Must register pets within 10 days of
I ■ <OR> at 6 months of age if puppy/Idttten-I residency.
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