Dog License Application

APPLICATION FOR A DOG LICENSE

Renewal ________ or New _______ license

Name of owner                                                                                                               Phone                                   

Address                                                                                                                                                                         

Name of dog                                                                                                                   Age                                       

Breed                                                                                                                              Color                                      

Male ($10.00)            Neutered Male *($5.00)              Female ($10.00)             Spayed female* ($5.00)             

Send check payable to Town of Leverett, business-size self-addressed stamped envelope, proof 
of rabies immunization, and *proof of spaying and neutering to Town Clerk, Box 300, Leverett 01054. 
Documents will be returned with license.