PHONE: 608/846-3802
FAX 608/846-3829 2006
APPLICANT:
DOG OWNER’S NAME:________________________________________________________
FIRST
NAME LAST
NAME
ADDRESS:_________________________________________________________________
NUMBER/STREET
CITY
ZIP
FEES: NEUTERED MALE/SPAYED FEMALE: $ 11.00 - OTHER MALE/FEMALE: $ 16.00
To obtain a Dog License in the Town of Vienna, the owner of a dog/s more than 5 months of age on Jan 1 of any year, or 5 months of age within the license year, shall annually, or on or before the date the dog becomes such age, provide the Town with a valid rabies vaccination certificate and pay the appropriate license fee. You may request your veterinarian to fax this certificate to the Treasurer at 846-3829 prior to the issuing of the license. The Town of Vienna imposes a $5.00 late dog license fee for all dogs licensed after April 1st. Additionally the Town will submit a listing of all dogs kept within the Town of Vienna-- licensed or not-- to Dane County on September 15th.
THE VALID RABIES VACCINATION CERTIFICATE MUST INCLUDE THE FOLLOWING: DATE OF SHOT, EXPIRATION DATE, MANUFACTURER, SERIAL NUMBER, TAG NUMBER OF SHOT AND SEX OF DOG. Without this information we are unable to complete the paperwork and the license will not be issued. Please complete the information below and enclose the appropriate fees along with the rabies certificate for each dog. If this is a renewal dog license with current rabies vaccinations NO certificate is required.
DOG INFORMATION REQUIRED FOR LICENSE
| DOG NAME | BREED | COLOR | SEX NEUTERED/ SPAYED DATE |
RABIES DATE |
VACCINE EXPIRES |
RENEWAL | FEES |
PLEASE MAKE A CHECK (SEPARATE FROM TAX PAYMENTS)
TO THE TOWN OF VIENNA FOR THE TOTAL FEES (FROM ABOVE INFORMATION): DUE
$_________
I, THE UNDERSIGNED, DO HEREBY CERTIFY THAT THE ABOVE-NAMED DOG/S HAS THE CURRENT RABIES VACCINATION AND IS NEUTERED/SPAYED AS STATED ABOVE.
SIGNATURE______________________________________
DATE_________________ PHONE ____________________
PLEASE RETURN ALL NECESSARY PAPERWORK AND
FEES TO THE ADDRESS ABOVE
----------
NOTE: IF FORM WON'T PRINT FROM BROWSER,
RIGHT CLICK IN HIS FRAME AND SELECT "OPEN THIS FRAME IN NEW WINDOW"
— THEN PRINT FROM NEW STAND-ALONE WINDOW.
