2012DOG LICENSE APPLICATION & INFORMATION

Statutes §174.05 & §95.21 provide that all dogs over 5 months of age shall be licensed and vaccinated.

All licenses expire on December 31, and must be renewed no later than March 31 of the following year.

After March 31, a late fee of $10.00 per tag must be paid in addition to the regular license fee.

No license shall be issued without proof that the dog has been vaccinated.

Toobtain a license, bring or mail all of the following items to the Town of Pleasant Springs

2354 County Highway N, Stoughton, WI53589

1. Current Certificate of Vaccination for each dog. This will be returned with your license(s).Service

invoices are not acceptable proof. Veterinarians must provide a Certificate of Vaccination.

2.Exact check made payable to “Town of Pleasant Springs” or exact cash. DO NOT MAIL CASH.

3.Completed Dog License Application. Incomplete applications cannot be processed.

4.Self addressed, stamped envelope with adequate postage. If you license 3 or more dogs, extra

postage is required. If you fail to enclose a SASE, you must pick up your license(s) in person.

Dog licenses are processed each Thursday following January 1st of each year. We accept licensing information and applications during all normal office hours.

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DOG LICENSE APPLICATION

Owner Last Name / Owner First Name / Phone
Address / City / Zip

Dog Information

Dog 1 / Dog 2 / Dog 3 / Dog 4
Name / Name / Name / Name
Breed / Breed / Breed / Breed
Color / Color / Color / Color
Vacc Due Date / Vacc Due Date / Vacc Due Date / Vacc Due Date
New  Renew /  / New  Renew /  / New  Renew /  / New  Renew / 
$ 13.00 Spayed F /  / $ 13.00 Spayed F /  / $ 13.00 Spayed F /  / $ 13.00 Spayed F / 
$ 13.00 Neutered M /  / $ 13.00 Neutered M /  / $ 13.00 Neutered M /  / $ 13.00 Neutered M / 
$ 18.00 Female /  / $ 18.00 Female /  / $ 18.00 Female /  / $ 18.00 Female / 
$ 18.00 Male /  / $ 18.00 Male /  / $ 18.00 Male /  / $ 18.00 Male / 

OFFICE USE ONLY BELOW THIS LINE

Vaccination Certificate ______
Dog License Fee $______
Late Fee $______
Dog 1 License Tag # ______
Dog 2 License Tag # ______
Dog 3 License Tag # ______
Dog 4 License Tag # ______/ When stamped “paid” by the Town of Pleasant Springs this will serve as your receipt. Licenses issued in 2012 are valid until December 31, 2012.

MULTIPLE DOG LICENSE APPLICATION

Business Name / FEIN
Business Owner Last Name: / Owner First Name / Phone
Address / City / Zip
New Issue /  / Number of dogs
Renew /  / Name of Veterinarian / Veterinarian Phone
Dog 1 / Dog 2 / Dog 3 / Dog 4
Name / Name / Name / Name
Breed / Breed / Breed / Breed
Color / Color / Color / Color
Vacc Due Date / Vacc Due Date / Vacc Due Date / Vacc Due Date
New  Renew /  / New  Renew /  / New  Renew /  / New  Renew / 
Spayed F /  / Spayed F /  / Spayed F /  / Spayed F / 
Neutered M /  / Neutered M /  / Neutered M /  / Neutered M / 
Female /  / Female /  / Female /  / Female / 
Male /  / Male /  / Male /  / Male / 
Dog 5 / Dog 6 / Dog 7 / Dog 8
Name / Name / Name / Name
Breed / Breed / Breed / Breed
Color / Color / Color / Color
Vacc Due Date / Vacc Due Date / Vacc Due Date / Vacc Due Date
New  Renew /  / New  Renew /  / New  Renew /  / New  Renew / 
Spayed F /  / Spayed F /  / Spayed F /  / Spayed F / 
Neutered M /  / Neutered M /  / Neutered M /  / Neutered M / 
Female /  / Female /  / Female /  / Female / 
Male /  / Male /  / Male /  / Male / 
Dog 9 / Dog 10 / Dog 11 / Dog 12
Name / Name / Name / Name
Breed / Breed / Breed / Breed
Color / Color / Color / Color
Vacc Due Date / Vacc Due Date / Vacc Due Date / Vacc Due Date
New  Renew /  / New  Renew /  / New  Renew /  / New  Renew / 
Spayed F /  / Spayed F /  / Spayed F /  / Spayed F / 
Neutered M /  / Neutered M /  / Neutered M /  / Neutered M / 
Female /  / Female /  / Female /  / Female / 
Male /  / Male /  / Male /  / Male / 

OFFICE USE ONLY BELOW THIS LINE

License Fee: $ ______
$106.00 for the first 1-12 dogs,
$ 18.00 for each dog thereafter.
Late Fee: $______
$10.00per individual dog license
Number of Tags Issued: ______
First Tag in Sequence ______
Last Tag in Sequence ______/ When stamped “paid” by the Town of Pleasant Springs this will serve as your receipt. Licenses issued in 2012 are valid until December 31, 2012.

Z:\Word files\Dogs\Dog License Application 2012.doc