Dog License Application

Document Overview

This document is a Dog License Application form issued by the PA Department of Agriculture, Bureau of Dog Law Enforcement. The form is designed to be printed and filled out manually. It appears twice on the page, likely intended for two separate applications or a "keep one copy" scenario.

Fees and Pricing

The application outlines specific fees based on the dog's gender and the owner's eligibility for discounts. All prices include service fees allowed by law.

• Regular Fee:
  • Male: $8. 70
  • Female: $8. 70
• Person with Disability or Senior Citizen Fee:
  • Male: $6. 70
  • Female: $6. 70

Important Note: If the license is issued by an agent rather than the County Treasurer, an additional 50 cents will be charged.

Required Information

To complete the application, the owner must provide details about both the dog and themselves.

Dog Details:

• Date of application
• Dog's Name
• Dog's Age
• Breed
• Color (Options: Spotted, White, Black, Brown, Other)

Owner Details:

• Owner's Name
• Telephone Number
• Date of Birth (Month, Day, Year)
• Street Address
• Township/Borough
• City
• State (PA)
• Zip Code
• E-mail Address

Eligibility and Verification

The form includes a legal declaration section at the bottom. The applicant must sign to verify they are the owner of the dog. This statement is subject to criminal penalties for unsworn falsification (18 Pa § Section 4904).

• Senior/Disability Requirement: If applying for the discounted fee, the owner must be a senior citizen (age 65 or older) or a person with a disability. Proof of age or disability must be provided to the County Treasurer or Agent.
• Minors: If the applicant is a minor, the signature of a parent or guardian is required.

Submission

The completed form should be mailed to the County Treasurer's Office.