QAug 06 19 07:63a Thone Animal Care
4024266808 P.1
'hone Animal Hospital
(402) 426-3630
902 S Hwy 30
[Blair, NE 68008
CITY OF RLAIR - 2019 PET LICENSE APPLICATION
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 • 218 S. 161" St. 0 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, 2019
Owner Name: <Y)Y) t J( I`,(x n
Owner Address:12
4, —
City/State/zip: glair, NE 68008
Phone x#
Drivers License # or pate of Birth!
LICENSE FEES: Dog or Cat: $16.00
Altered Dog or Cat: $11.00
Replacement Fee for Lost Tag: $5.00
***PLEASE READ CAREFULLY***
YOU ARE REQUIRED BY LAW TO LICENSE YOUR PETS,
Failure to do 90 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 3/15/201B. 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 Cityof Blair requires proof of rables vaccination.
lncivaea Is a State Fee of $1.2-5 being collected to fund the Nebraska Don & Cat
PEN #� 14 Dog ❑ Cat NrSpayed/Neutered License Fee $
Pet�}U J l o lrv,_ Sex � i
color=�— Breede* LtL Replacement$ x
Declared Dangerous or Potentially Dangerous Dog: ❑ Y N
MICROCHIP # (If applicable) SUBTOTAL: $ I' � G
RABIES VACCINATION DATE: la- g_j(3 yr) (i yr) City Tag #
POET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $
Pet Name Ale Sex
Color Breed * Replacement $ **
Declared Dangerous or Potentially Dangerous Dog: Q Y q N
MICROCHIP # (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE: (3 yr) (I yr) City Tag #
PET #3 ❑ Dog ❑ Cat ❑ Spayed/Neutered License Fee $
Pet Name Aye Sex
Color Breed * Replacement $ **
Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N
MICROCHIP # (If applicable) SUBTOTAL: $
RABIES VACCINATION DATE: (3 yr) (I 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.)
Donation to care for animals: $1 $3 $5 $10 Other
***SEE BACK OF FORM FOR BREED SPECIFIC LICENSE REQUIREMENTS
VISA / MC #
Signature
Do Not Send Gash by Mail TOTAL ENCLOSED $
Expires: Security C-ode:
If you have questions, please contact City Hall at (402) 426.4191 or by Fax: (402) 426-4195
+-F....+-I-+-M*++++++*4+++++*.*++-F ..........1-+-1-t++*++++++-I-t 4.......................
NEW PET/NEW RESIDENT LICENSING REQUIREMENTS (Mardi 151atefeedate notapp)lcablefornewpety/newresldents)
Newly Acquired Pets: New Residents to Blair:
■ Must be licensed within 10 days of ownership ■ Must register pets within 10 days of
it <OR> at 6 months of age if puppy/kitten residency,