Multi-Pet Permit Application

2. Date
   Date

   Date

4. First Name

5. Last Name

7. Address1

9. Address2

11. City

12. State

13. Zip

15. Phone Number

16. Alternate #

18. Email

22. Number of Dogs

23. Indoor / Outdoor

    1. Indoor
    2. Outdoor

25. Are all dogs spayed or neutered?

    1. Yes
    2. No

26. If no, how many are not sterilized?

28. Are all the dogs current on rabies vaccinations?

    1. Yes
    2. No

29. Have vaccinations been verified?

    1. Yes
    2. No

31. Type of Identification Used

    1. Registration
    2. Personal
    3. Microchip

35. Number of Cats

36. Indoor / Outdoor

    1. Indoor
    2. Outdoor

38. Are cats spayed or neutered?

    1. Yes
    2. No

39. Are non-steralized cats allowed to roam outdoors?

    1. Yes
    2. No

41. Are non-steralized cats current on rabies vaccinations?

    1. Yes
    2. No

42. Have vaccinations been verified?

    1. Yes
    2. No

44. Type of Identification Used

    1. Registration
    2. Personal
    3. Microchip

48. Have valid complaints been filed?

    1. Yes
    2. No

49. Type of Complaint Filed

51. Was an inspection required?

    1. Yes
    2. No

55. Permit Granted

    1. Yes
    2. No

57. Date Payment Received

58. Payment Type

    1. Cash
    2. Check
    3. Other

59. Check # / Other

61. Permit Mailed

63. Signature of IAS Designee

Leave This Blank:


64. Print Only

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