CITY OF STARKVILLE, MS
APPLICATION FOR ANNUAL DOG LICENSE
(Administered by Oktibbeha County Humane Society)
Dog’s Name ______NEW COMPUTER PROGRAM SO
PLEASECOMPLETE ALL INFORMATION
Renewals may be mailed ($1 extra per).
Owner ______
Address ______P.O. Box or Apt #______
Phone 1 ______Phone 2 ______E-Mail ______
(area code & #)
Breed (predominant breeds) ______
Description (include weight and visible scars/incisions)______
______
Date of Birth ___/____/______Sex ______Neutered/Spayed?______Renewal? ____
(estimate if necessary) (First time attach proof to receive reduced fee)
Rabies shot date & tag ___/_____/_____ Tag#______ (show tag or certificate as proof)
Microchip? ______Brand and identification number ______
Tattoo? ______Describe and location ______
Veterinarian’s Name ______
Address & Phone(if not local)______
YOU ARE REQUIRED TO NOTIFY OCHS OF THE DEATH OR SALE OF THIS DOG AND IF YOU CHANGE ADDRESS/PHONE.
The information provided by me is correct and complete. I acknowledge that to provide false information is against the law.
______(Date) ______
(Signature)
OCHS Witness ______(Date) ______
___FEE $5/$6 by mail (neutered/spayed) ___FEE $10/$11 by mail (not altered) Check #______
NEW CITY LICENSE TAG # ______IF LOST, REPLACEMENT # ______ YEAR: 2013
Bring this form, along with appropriate fee, rabies proof and neuter/spay documentation (if first time)
In person at:
OCHS/City of Starkville Animal Shelter
510 Industrial Park Road, Starkville
Open: Mon - Fri, 10am- 5:30 pm Sat, 10 –2pm
By mail: (include $1 extra per license)
OCHS/City of Starkville Animal Shelter
P.O. Box 297
Starkville, MS 39760
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RECEIPT FOR ANNUAL DOG LICENSECITY OF STARKVILLE, MS
Dog’s Name ______RENEWAL? ______
Owner ______Address______
___FEE $5/$6 by mail (neutered/spayed) ____ FEE $10/$11 by mail (not neutered/spayed)
NEW CITY LICENSE TAG # ______IF LOST, REPLACEMENT # ______ YEAR: 2013
YOU ARE REQUIRED TO NOTIFY OCHS OF THE DEATH OR SALE OF THIS DOG AND IF YOU CHANGE ADDRESS/PHONE. CALL OR MAIL TO OCHS, P.O. Box 297, STARKVILLE, MS 39760
Registrar______date______Oktibbeha Cty Humane Society, 662 338-9093