Dog Application


	Age


	Please print and complete the form below and mail to our office with a check for $8.00 for each dog.


	Please enclosed a self-addressed stamped envelope.


	Sex


	*Certificate* for the registration of dog for the year _____

Year	Month	M/F	Color	Hair	Breed	Fees	Penalty	Tag No.


	A penalty shall be assessed if Dog License is not secured on or before January 31, or within 30 days after the dog becomes 3 months of age, or is brought from outside the state R.C. Sec. 955.01.05

	The undersigned says that the facts indicated above ARE TRUE.

	Name: _____________________

	Address:_____________________

	City/State/Zip____________________

	Signature of Applicant ______________________

	Telephone No. ________________ Date ____________________

		Pike County Government Center 230 Waverly Plaza Suite 200 Waverly, OH 45690-1222 740 947 2713