ARLINGTON COUNTY, VIRGINIA - arlingtonva.s3.amazonaws.com

ARLINGTON COUNTY, VIRGINIA

OFFICE OF THE COUNTY TREASURER OPERATIONS DIVISION

2100 CLARENDON BOULEVARD, SUITE 215 ARLINGTON, VA 22201

CARLA DE LA PAVA TREASURER

DOG LICENSE APPLICATION

STEPHANIE A. HYMAN DEPUTY TREASURER

By Mail: Please complete the application below and return it, along with a copy of the current rabies vaccination certificate and a check for $30.00 made payable to TREASURER, ARLINGTON COUNTY. Mail to:

Office of the County Treasurer, Operations Division 2100 Clarendon Boulevard, Suite 215 Arlington, VA 22201

In Person: Please complete the application below, and return it between the hours of 8:00am to 5:00pm, Monday through Friday, along with the current rabies vaccination certificate to:

Office of the County Treasurer 2100 Clarendon Blvd Suite 215 (2nd Floor) Arlington, VA 22201 Payments may be made by cash, check, money order, debit card or credit card. Note: Credit card payments are subject to a convenience fee, charged directly to you by our service provider.

Owner Information: Name: _________________________________________________ Phone: ________________________ SSN: ________/________/___________ OR Driver's License & State issued: __________________ - _______ Co-Owner: ______________________________________________ Phone: ________________________ SSN: ________/________/___________ OR Driver's License & State issued: __________________ - _______ Address: _________________________________________________________________________________ City: _______________________________________________ State: _________ Zip: ___________ Email address: _____________________________________________________________________________

Dog Information: Dog's Name: _____________________________________ Date of Birth: ______/______/______ Est. Adult Weight: ____________ Color/Identifying Marks: _____________________________

Breed: _________________________ Sex: ______ Male ______ Female Spayed/Neutered: ____ Yes ____ No Hair: _______ Short or ________Long

Rabies Shot: _______/______/______

Type of Shot: _____ 1 Yr. _____ 3 Yr.

Please note that a license shall not be issued without a current rabies vaccination, and the appropriate rabies certificate must accompany this application.

Dog License Fees are Nonrefundable.

Remember...your dog's license could be the ticket home should he or she become lost!

Notice: Arlington County Code prohibits more than three dogs per household unless the location has been approved for use as a kennel by the Arlington County Zoning Administrator and a kennel license has been

obtained.

________________________________________________ Signature

_________________________ Date

email: treasureroperations@arlingtonva.us phone: 703-228-3090 fax: 703-228-7081 Visit us on the Web at arlingtonva.us/treas

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