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Animal License Application

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
17. Driver's License #
19. 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.
21. Animal #1
23. Type of Animal*
    -- Select One --DogCat
25. Name:
26. Age (specify months or years):
27. Color(s):
28. Breed(s):
30. Sex:

    1. Male
    2. Female
31. Altered?

    1. Yes
    2. No
32. Microchip #:
34. Animal #2
36. Type of Animal*
    -- Select One --DogCat
38. Name:
39. Age (specify months or years):
40. Color(s):
41. Breed(s):
43. Sex

    1. Male
    2. Female
44. Altered?

    1. Yes
    2. No
45. Microchip #:
47. Animal #3
49. Type of Animal*
    -- Select One --DogCat
51. Name:
52. Age (specify months or years):
53. Color(s):
54. Breed(s):
56. Sex:

    1. Male
    2. Female
57. Altered?

    1. Yes
    2. No
58. Microchip #:
60. Animal #4
62. Type of Animal*
    -- Select One --DogCat
64. Name:
65. Age (specify months or years):
66. Color(s):
67. Breed(s):
69. Sex:

    1. Male
    2. Female
70. Altered?

    1. Yes
    2. No
71. Microchip #:
73. Animal #5
75. Type of Animal*
    -- Select One --DogCat
77. Name:
78. Age (specify months or years):
79. Color(s):
80. Breed(s):
82. Sex:

    1. Male
    2. Female
83. Altered?

    1. Yes
    2. No
84. Microchip #:
86. Animal #6
88. Type of Animal*
    -- Select One --DogCat
90. Name:
91. Age (specify months or years):
92. Color(s):
93. Breed(s):
95. Sex:

    1. Male
    2. Female
96. Altered?

    1. Yes
    2. No
97. Microchip #:
99. Service animal

    1. One of my animals is a service animal.
101. Payment:
     To pay for your license online, please click here.

     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.
103. You may also send a check or money order, made out to the City of Sultan, to City Hall at PO Box 1199, Sultan, WA 98294.
105. 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
107. 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.
109. 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.
111. 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.
113. Electronic Signature
Leave This Blank:


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

     This field is not part of the form submission.

117. Submit Submit and Print

* indicates a required field