Chattanooga City Pet License Application

A SEPARATE LICENSE APPLICATION MUST BE FILLED OUT FOR EACH ANIMAL

NOTE: Upload of Current Rabies Certificate Required To Complete This Form Submission of a false statement is violation of applicable law for which you may be subject to civil and criminal penalties. and which may result in invalidating a license issued.

OWNER INFORMATION

First Name *

Middle Initial

Last Name *

Person ID Number (If Known) :

If you received a reminder card in the mail, your Person ID # will be under your name on address label. It will also be found on your past McKamey receipt in the upper right hand corner,

Drivers License # *

License State of Issue *

Birth Date *

Date

Address *

Address 2

City *

State *

Zip Code *

Primary Phone # *

Other Phone #

Work Phone #

E-Mail *

New License OR Renewal? *

New License Renewal

If Renewal, Provide Current License Number

PET INFORMATION

Name of Pet *

Species *

Dog Cat

Primary Color: *

Secondary Color:

Breed *

Size of Pet *

Small Medium Large

Age of Pet: *

Sex of Pet *

Male Female Neutered Male Spayed Female I have a Neutered Male & I am 65 yrs or older. I have a Spayed Female & I am 65 yrs or older.

PROOF OF CURRENT RABIES VACCINATION (RABIES CERTIFICATE) IS REQUIRED WHEN PURCHASING A CITY LICENSE!

Upload Rabies Certificate: (JPEG & PDF Files Only... 20MB MAX) Current rabies certificate is required by law.

Attachment *

Rabies Expiration Date *

- Month - Day Year

Please note, your new city license will expire the last day of the month that your rabies vaccination expires. We prefer you purchase your city license within 30 days after your pet receives their rabies vaccination.

This dog is Guard Dog Trained

No Yes

NOTE: Guard dogs require special registration. Contact McKamey.

This dog is a Registered Service Dog

No Yes

Total number of dogs in household: *

Total number of cats in household: *

Do you have MORE than 7 pets? *

No Yes

NOTE: $50.00 Multi-Pet Permit Is Required! Contact McKamey for Multi Pet Permit Application!

Do you breed dogs & cats?

No Yes

NOTE: $250.00 Breeder Permit Is Required! Contact McKamey for Breeder Permit Application!

AMOUNT DUE:

$11.00 ($10 + $1 postage & handling)

$51.00 ($50 + $1 postage & handling)

$1.00 - ($1 postage & handling) 65 & Over - Up to 3 altered pets

CREDIT CARD INFORMATION

I authorize McKamey to charge my credit card for the amount of: *

$51.00 $11.00 $1.00

Name On Card *

Credit Card Type *

Card Number

Card Number AMEX

Expiration Date *

Month / Year: 05/2015

Security Code *

Billing Zip Code *

How Many License Applications Will You Be Submitting? *