CITY OF PORTERDALE
ANIMAL REGISTRATION CERTIFICATE
PRINT CLEARLY
Owner's Name & Address
LAST

FIRST

M. I.         
STREET ADDRESS:
City State Zip Code
(Home Phone #)
(Work Phone #)
OWNER'S SIGNATURE:
____________________________________________
RABIES TAG #:
MICROCHIP # (if applicable):
SPECIES

  Dog

  Cat

  Ferret

  Other

Specify if other:
ANIMAL'S NAME
 ANIMAL'S AGE:
Month: 
Year: 

 
FOR OFFICIAL USE ONLY DATE REGISTERED WITH CITY
______________    _____________    _____________
Month

Day

Year
Signature of Authorized Representative of City
____________________________________________
$5.00 Fee Payment:
 _____Cash
 _____Check
Check No. _________________
ANIMAL'S SEX
Male
Female
Neutered
SIZE:
Under 20 lbs.
20 - 50 lbs.
Over 50 lbs.
Predominant Breed:
Predominant Color/Markings:
NOTES:
  • Animals must be registered with the City annually. The annual date for registration is within one year of the date entered as the "Date Registered With City" on the form.
  • A current Rabies Vaccination Certificate is required to register an animal with the City.
  • Your copy of this Registration Certificate constitutes your receipt for payment of the required Registration Fee.
  • You should keep your copy of this Registration Certificate in a safe place, as presentation of the Certificate may be required to retrieve the Registered animal if impounded pursuant to the City's Animal Control Ordinance.