NEW DOG LICENSE APPLICATION
TOWN OF HERKIMER
KRYSTAL MOORE, TOWN CLERK
PLEASE PRINT CLEARLY:
Print and complete this form. Remit it either in person, by mail or using the drop box outside the Town Office, with the following:
- Completed Application form
- Appropriate fee
- Spay/Neuter Certificate
- Proof of current rabies vaccination, signed by a licensed veterinarian
OWNER INFORMATION:
Blank fields on the printed form:
- Name:
- Mailing Address:
- Zip Code:
- Phone Number:
- Email Address:
DOG INFORMATION:
Blank fields on the printed form:
- Dog Breed:
- Dog Color(s):
- Other Markings:
- Microchip or Tattoo:
- Dog's Name:
- Birth Year:
- Veterinarian:
- Vaccination Date:
SELECT ONE LICENSE FEE:
- Male, neutered
- $10.00
- Male, unneutered
- $20.00
- Female, spayed
- $10.00
- Female, unsprayed
- $20.00
TOTAL LICENSE FEE $ (blank on the printed form)
MAKE CHECKS PAYABLE TO: The "Town of Herkimer"
MAIL FORMS TO: HERKIMER TOWN CLERK, 114 N. PROSPECT STREET HERKIMER, NY 13350
QUESTIONS: PLEASE CALL KRYSTAL MOORE, 315-866-2690 EXT. 3