Pa Dog License Form PDF Details

Navigating through the necessities of dog ownership within Pennsylvania requires adherence to state regulations, one of which is the acquisition of a dog license. The Pennsylvania Department of Agriculture, Bureau of Dog Law Enforcement, facilitates this through the Lifetime Dog License Application, documented as ADLEB 19 rev. 9/2010. This comprehensive form serves not just as a means to register one’s pet but also embeds important identification and owner verification processes. Key sections include detailed owner information such as name, birthdate, and contact details along with their dog's name, breed, age, and distinguishing color or markings. A distinct acknowledgment within the form is the categorization of license fees, varying for regular dogs versus those owned by persons with disabilities or senior citizens, emphasizing the inclusivity of the state's regulations. Additionally, the form stipulates the requirement for a Permanent Identification Verification Form before issuance, thereby ensuring a thorough validation process. With embedded service fees acknowledged by law, the form outlines financial obligations alongside legal affirmations by the dog owner or guardian, if the applicant is a minor. Mailing instructions to the County Treasurer’s Office conclude the application process, encapsulating the procedural framework for securing a dog's lifetime licensure within Pennsylvania.

QuestionAnswer
Form NamePa Dog License Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namespa dog license monroe county, UNSWORN, 2010, SPAYED

Form Preview Example

ADLEB 19 rev. 9/2010

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

$51.45

$31.45

$51.45

$31.45

 

$31.45

$21.45

 

$31.45

$21.45

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

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