Lifetime Dog License Form PDF Details

The Pennsylvania Department of Agriculture, through its Bureau of Dog Law Enforcement, has outlined a structured process for dog owners opting for a Lifetime Dog License, as detailed in the ADLEB 19 rev. 9/2014 form. This comprehensive application not only captures essential information about the dog, including name, breed, age, color, and markings but also stipulates that a Permanent Identification Verification form—either a microchip or tattoo number—is required for the license to be issued. The form accommodates different fee structures depending on the dog's neuter status and the owner's eligibility as a senior citizen or a person with a disability, highlighting inclusivity and consideration for varying personal circumstances. Additionally, it mandates the authentication of the owner's claim to the dog, under penalty of law for falsification, and underscores the importance of timely submission to the relevant County Treasurer’s Office. The detailed attention to verification and validation processes underscores the state’s commitment to responsible dog ownership and public safety.

QuestionAnswer
Form NameLifetime Dog License Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameslifetime license dog pa, pa dog license, pa lifetime license dog, dog lifetime license pa

Form Preview Example

ADLEB 19 rev. 9/2014

PA Department of Agriculture, Bureau of Dog Law Enforcement

LIFETIME DOG LICENSE APPLICATION

Year of license

A Permanent Identification Verification Form must be completed before the license will be issued.

DOG OWNER’S NAME

 

 

 

 

 

OWNER’S BIRTHDATE

 

PHONE NUMBER

 

 

 

 

 

 

 

 

 

MO.

 

DAY

 

YR.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

 

 

 

 

 

 

TOWNSHIP/BOROUGH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

BREED

 

 

 

DOG’S AGE

 

DOG’S NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COLOR /

 

SPOTTED

WHITE

BLACK

 

 

BROWN

 

OTHER-INDICATE

MARKINGS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REGULAR LIFETIME LICENSE

 

 

 

 

 

PERSON WITH DISABILITY

 

 

 

 

 

 

 

 

 

 

 

 

 

OR SENIOR CITIZEN FEE

 

 

NEUTERED

 

 

SPAYED

 

 

 

 

 

NEUTERED

 

 

 

SPAYED

MALE

MALE

 

FEMALE

FEMALE

 

 

MALE

 

MALE

 

FEMALE

FEMALE

$51.50

$31.50

$51.50

$31.50

 

$31.50

$21.50

 

$31.50

$21.50

ALL PRICES INCLUDE SERVICE FEES

 

 

 

 

 

ALL PRICES INCLUDE SERVICE FEES

 

ALLOWED BY LAW

 

 

 

 

 

 

 

 

 

ALLOWED BY LAW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLEASE NOTE: If you are applying for a lifetime license that requires the dog owner be a senior citizen (age 65 or older) or a person with disability, you must provide proof of age or disability to the County Treasurer.

I HEREBY VERIFY THAT I AM THE OWNER OF THE DOG THAT IS THE SUBJECT OF THIS DOG LICENSE

APPLICATION. I MAKE THIS STATEMENT SUBJECT TO THE CRIMINAL PENALTIES OF 18 Pa § SECTION 4904

(RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES).

SIGNATURE OF DOG OWNER/APPLICANT REQUIRED

IF APPLICANT IS A MINOR, SIGNATURE OF PARENT OR GUARDIAN IS REQUIRED

MAIL TO COUNTY TREASURER’S OFFICE

ADLEB – VOM/TF

DOG LAW ENFORCEMENT OFFICE

PENNSYLVANIA DEPARTMENT OF AGRICULTURE

PERMANENT IDENTIFICATION

 

 

VERIFICATION FORM

 

 

 

 

MICROCHIP # _________________________________ OR

TATTOO # _________________________________

MUST BE COMPLETED BY PERSON IMPLANTING OR SCANNING MICROCHIP

 

MUST BE COMPLETED BY COUNTY TREASURER PRIOR TO TATTOOING

 

 

 

 

 

 

DOG’S NAME _______________________________________

NEUTERED

SPAYED

MALE MALE FEMALE FEMALE

 

 

 

 

DOG’S BREED ____________________ DOB _____________ DOG’S SEX

 

 

 

 

 

 

 

SPOTTED

WHITE BLACK

 

BROWN OTHER–INDICATE

 

DOG’S COLOR/MARKINGS

 

 

 

_________________________

 

 

 

 

 

 

OWNER’S NAME

 

STREET

 

 

 

 

 

 

 

 

 

CITY

TOWNSHIP

STATE ZIP

TELEPHONE NO.

PA

COUNTY

NAME OF PERSON CIRCLE ONE MICROCHIP-IMPLANTING OR SCANNING OR TATTOOING

VETERINARIAN PRACTICE # (TATTOO OR MICROCHIP)

 

BV

 

 

STREET

PA KENNEL LICENSE # (MICROCHIP)

 

 

COUNTY

CITY

STATE

ZIP

TELEPHONE NO.

I MAKE THIS STATEMENT SUBJECT TO THE CRIMINAL PENALTIES OF

18 PA. C.S. § SECTION 4904 (RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES).

SIGNATURE OF PERSON IMPLANTING/SCANNING MICROCHIP/TATTOOING

DATE

 

 

SIGNATURE OF DOG OWNER

DATE

FORM MUST BE RETURNED TO COUNTY TREASURER WITHIN 30 DAYS OF RECEIPT _________________________________

FORM IS VOID IF NOT RETURNED TO TREASURER ON OR BEFORE DATE LISTED.

How to Edit Lifetime Dog License Form Online for Free

Working with PDF files online is always very simple with this PDF tool. You can fill out dog license pa lifetime here and use many other options we offer. The tool is constantly upgraded by our team, receiving powerful features and turning out to be more versatile. To begin your journey, consider these basic steps:

Step 1: First, access the pdf tool by clicking the "Get Form Button" at the top of this page.

Step 2: The tool will let you change PDF forms in a variety of ways. Enhance it with any text, adjust original content, and include a signature - all at your disposal!

This form requires particular details to be filled in, so you should definitely take the time to enter what is expected:

1. The dog license pa lifetime necessitates particular information to be entered. Make certain the subsequent blank fields are finalized:

Filling in section 1 in dog license lifetime pa

2. Once your current task is complete, take the next step – fill out all of these fields - ALL PRICES INCLUDE SERVICE FEES, ALL PRICES INCLUDE SERVICE FEES, ALLOWED BY LAW, ALLOWED BY LAW, PLEASE NOTE If you are applying, I HEREBY VERIFY THAT I AM THE, APPLICATION I MAKE THIS STATEMENT, RELATING TO UNSWORN FALSIFICATION, SIGNATURE OF DOG OWNERAPPLICANT, IF APPLICANT IS A MINOR SIGNATURE, and MAIL TO COUNTY TREASURERS OFFICE with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Filling in segment 2 in dog license lifetime pa

3. Completing MICROCHIP or TATTOO, MUST BE COMPLETED BY PERSON, DOGS NAME, SPAYED MALE MALE FEMALE FEMALE, NEUTERED, DOGS BREED DOB DOGS SEX, SPOTTED WHITE, BLACK BROWN OTHERINDICATE, DOGS COLORMARKINGS, OWNERS NAME, STREET, CITY, TOWNSHIP, TELEPHONE NO, and STATE ZIP PA is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

DOGS NAME, DOGS COLORMARKINGS, and MICROCHIP   or TATTOO in dog license lifetime pa

Be really mindful when filling out DOGS NAME and DOGS COLORMARKINGS, since this is the section where most users make a few mistakes.

4. To go onward, this step will require filling in a few empty form fields. These comprise of SIGNATURE OF PERSON, DATE, SIGNATURE OF DOG OWNER, DATE, FORM MUST BE RETURNED TO COUNTY, and Form is VOID if not returned to, which you'll find fundamental to moving forward with this particular process.

The best ways to complete dog license lifetime pa portion 4

Step 3: Prior to moving forward, it's a good idea to ensure that form fields have been filled in the right way. When you verify that it is correct, click “Done." After getting afree trial account here, it will be possible to download dog license pa lifetime or email it right off. The document will also be easily accessible from your personal account with all your changes. FormsPal is invested in the confidentiality of our users; we make certain that all personal data coming through our tool continues to be protected.