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Printable Application Form
APPLICATION FOR ANIMAL LICENSE
POB 569 CITY OF OMAK 826-0383
Color_______________________ CAT_______ DOG________ Purebred: yes no
Male___________ Female___________ Altered: yes no
Breed______________________________ Name________________________
License #___________________________ Rabies Vaccination (year)________
_______________________________________________________________________
Color______________________ CAT_______ DOG________ Purebred: yes no
Male___________ Female____________ Altered: yes no
Breed______________________________ Name________________________
License #___________________________ Rabies Vaccination (year)________
_______________________________________________________________________
_______________________________________________________________________
Owner
_______________________________________________________________________
Street Address
_______________________________________________________________________
Mailing Address
_______________________________________________________________________
Phone or Message Phone
I certify this information is true and correct. (Only two dogs {three cats} per residence.)
___________________________________________________________Date _______________
Signature
License Fee________________Fertile 10.00
Sterile 5.00
Misc. Fee__________________Late 15.00
Impound 30.00
Late Fee__________________ Board per Day 7.50
Log #______________
Total Fee_________________ Receipt #_________
Questions? Call Animal Control Officer Marv Kruger. | 
