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2. City of Sultan Animal License Application
   License tag must be affixed to animal.
4. Year of License:*
5. Renewal? *

   1. New
   2. Renewal/Replacement
7. Owner Name*
8. Email Address
10. Address*
12. City
13. State
14. Zip Code
16. Phone Number
18. Pet Information:
    Note: We understand that spaying/neutering an animal earlier than 5-6 months of age is not recommended by veterinarians. We will allow a license to be issued early as long as the owner promises that the puppy/kitten is spayed/neutered and microchipped by the time they are 6 months old.
20. Animal #1
22. Type of Animal*
    -- Select One --DogCat
24. Name:
25. Age (specify months or years):
26. Color(s):
27. Breed(s):
29. Sex:

    1. Male
    2. Female
30. Altered?

    1. Yes
    2. No
31. Microchip #:
33. Animal #2
35. Type of Animal*
    -- Select One --DogCat
37. Name:
38. Age (specify months or years):
39. Color(s):
40. Breed(s):
42. Sex

    1. Male
    2. Female
43. Altered?

    1. Yes
    2. No
44. Microchip #:
46. Animal #3
48. Type of Animal*
    -- Select One --DogCat
50. Name:
51. Age (specify months or years):
52. Color(s):
53. Breed(s):
55. Sex:

    1. Male
    2. Female
56. Altered?

    1. Yes
    2. No
57. Microchip #:
59. Animal #4
61. Type of Animal*
    -- Select One --DogCat
63. Name:
64. Age (specify months or years):
65. Color(s):
66. Breed(s):
68. Sex:

    1. Male
    2. Female
69. Altered?

    1. Yes
    2. No
70. Microchip #:
72. Animal #5
74. Type of Animal*
    -- Select One --DogCat
76. Name:
77. Age (specify months or years):
78. Color(s):
79. Breed(s):
81. Sex:

    1. Male
    2. Female
82. Altered?

    1. Yes
    2. No
83. Microchip #:
85. Animal #6
87. Type of Animal*
    -- Select One --DogCat
89. Name:
90. Age (specify months or years):
91. Color(s):
92. Breed(s):
94. Sex:

    1. Male
    2. Female
95. Altered?

    1. Yes
    2. No
96. Microchip #:
98. Service animal

    1. One of my animals is a service animal.
100. Vaccination:

     Distemper/parvovirus is not mandatory but is highly recommended. Do your pets have this vaccine?

     1. The above animals are vaccinated for distemper/parvovirus.
102. Animal Owner's Certification:*

     As Applicant, I certify and declare under penalty of perjury under the laws of the State of Washington and City of Sultan that: all animals at the above address are licensed with current tags and tags are displayed on animals, the information on this application is true and correct, and the animal(s) listed hereon have a current rabies vaccination.

     1. I agree.
104. Payment:
     To pay for your license online, please click here.

     PLEASE BE ADVISED: By clicking the submit button shown below the website does not automatically route you to the payment page. Please follow the link shown to pay before completing this application process.

     Notes for the payment page: Instead of "Account Number", type "Pet License: [Your Name]". A $2.00 service fee is applied to checking/savings account payments. A 4% service fee is applied to debit/credit card payments. Please ensure that you pay the correct amount.

106. Price per license:

     1. Altered animal: $16 per animal
     2. Unaltered: $36 per animal
     3. Altered (senior rate): $14 per animal
     4. Altered w/ microchip $8 per animal
     5. Unaltered w/ microchip: $18 per animal
     6. Altered w/ microchip (senior rate): $7 per animal
     7. Unaltered w/ microchip (senior rate): $17 per animal
     8. Cat (free): $0
     9. Replacement fee for lost/damaged tags (each time): $5 per tag

108. Other payment options:

     Mail a check or money order payable to the City of Sultan, PO Box 1199, Sultan, WA 98294.

     Payment drop boxes at the following locations:

     * City Hall, 319 Main Street, just inside front doors

     * Post Office, 102 4th Street, outside the main entrance in alcove to the left.

     NOTE: Licenses will be mailed to you upon receipt of payment.

110. Electronic Signature Agreement*

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
112. Electronic Signature
Leave This Blank:


114. 1. Receive an email copy of this form.
115. Email address

     This field is not part of the form submission.

116. Submit Submit and Print

* indicates a required field