QJan 09 23 12:59p
PA
CITY OF BLAIR - 2023 PET LICENSE APPLICATION
If you live in Blair City limits and own a clog(s) and/or cat(s), complete this form and return with check made payable to:
City of Blair • 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. 2023
Owner Name:
owner Address: a5 r f�2
city/state/zip: Blair, NE 68008
Phone # 2, Z_
LICENSE FEES: Dog or Cat: $16.00
Alt d Do or Cal-. $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 3l15/2023. Tne City shall
recognize a microchip identification number as the license number. It
shall be unlawful for any dig 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 reAuiras proof of rabies vaccination 60
in submitted with your Ilcen98_aiicatio
WSW g
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
PET #1 lid Dog ❑ Cat ❑ Spayed/Neutered License Fee $ l 1._„Uy
Pet Name c Birthdate o�2elq Sex a e_1_— **
Color Breed** Replacement $
Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ N #68
MICROCHIP # (If applic le) SUBTOTAL: $
RABIES VACCINATION DATE: Q 3'/z� ( (1 yr) City Tag #
PET #2 ❑ Dog ❑ Cat ❑ Spayed/Neutered
Pet Name Birthdate Sex _
Color Breed**
Declared Dangerous or Potentially Dangerous Dog: ❑ Y ❑ i\
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) —
M
License Fee $ -
Replacement $ **
SUBTOTAL: $ -
(1 yr) City Tag #
License Fee $
Replacement $
SUBTOTAL: $
(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.)
TOTAL ENCLOSED $
Do Not Send Cash by Mail
If you have questions, please contact Blair Police Department at (402) 426-4747
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NEW PET/NEW RESIDENT L'I)CENSINGREQUIREMENTS (Matoi15/atefeea fenotapA able for newpeis/nevres/d&7t5)
N...red Pets., New Residents to Blair•
N Must be 11censed within 10 days of annership ■ Must register pets within 10 days of
■ <OR> at 6 months of age W puppy/kitban residency.