Lifetime Dog License Application

Document Overview

This document is a Lifetime Dog License Application form issued by the PA Department of Agriculture, Bureau of Dog Law Enforcement. The form is designed to be printed double-sided (two pages per sheet), as indicated by the identical content appearing on both the left and right sides of the image.

Key Requirements

• Verification Form: A "Permanent Identification Verification Form" must be completed before the license is issued.
• Eligibility: The application covers lifetime licensing for dogs in Pennsylvania.
• Senior/Disability Proof: Applicants claiming the senior citizen or disability fee must provide proof of age (65+) or disability to the County Treasurer.
• Legal Statement: The applicant must sign a statement verifying ownership, subject to criminal penalties for unsworn falsification (18 Pa § Section 4904).

Fees and Pricing

The form lists specific fees for lifetime licenses. All prices include service fees allowed by law.

Regular Lifetime License

• Male: $52. 70
• Female: $52. 70

Person with Disability or Senior Citizen Fee

• Male: $36. 70
• Female: $36. 70

Required Information Fields

Applicants must fill out the following sections:

• Owner Details: Name, Birthdate (Month/Day/Year), Phone Number, Email Address.
• Address: Street Address, Township/Borough, City, State (PA), and Zip Code.
• Dog Details: Date of application, Breed, Dog's Age, Dog's Name.
• Dog Description: Color/Markings (Spotted, White, Black, Brown, or Other).

Submission Instructions

• Signature: The "Signature of Dog Owner/Applicant" is required.
• Minors: If the applicant is a minor, the signature of a parent or guardian is required.
• Mailing: The completed form should be mailed to the County Treasurer's Office.

Document Metadata

• Form ID: ADLEB 19 rev. 12/2023
• Jurisdiction: Pennsylvania (PA)