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Erie 2021 Dog License Application
Erie 2021 Dog License Application
2021
2020CITY
CITYOF
OFERIE
ERIEDOG
DOGLICENSE
LICENSE APPLICATION
APPLICATION
07/19/2021
DATE OF ISSUE: ____/_____/______ 2019 TAG NUMBER____________ NEW TAG NUMBER_______
I hereby verify that I am the owner of the dog that is subject of the dog license application and the information
above is correct or corrected on the reverse side of this stub. I make this statement subject to the criminal
penalties 18 § Section 4904 relating to unsworn falsification to authorities
Michael Haas
OWNER’S NAME (PLEASE PRINT): ________________________________________________________
OWNER’S SIGNATURE: ____________________________________________________________
ADDRESS:509 Cranberry Street
____________________________EMAIL: ____________________________________
Erie
CITY: _______________________________ PA
STATE: ___________________ 16507
ZIP: ____________
+18149231563
DAYTIME PHONE #: (_____) _________________ Secondary Phone #:(_____) ________________
OWNER’S BIRTH YEAR : _________
CIRCLE ALLTheo
THAT APPLY: MALE FEMALE
SPAYED
4781 LT
Australian
NEUTERED Black/brown MALE
DOG NAME____________ TAG#_____________ BREED____________ COLOR____________ GENDER_____
BREED: _________________ COLOR: __________Shepherd
AGE: ____PET’S NAME: ________________
DOG NAME_______________ TAG#_____________ BREED____________ COLOR____________ GENDER_____
YEARLY LICENSE FEES MICRO CHIPPED LIFETIME LICENSE FEES
DOG NAME____________ TAG#_____________
$8.00 MALE/FEMALE Micro ChipCOLOR____________
(3 months or older)BREED_____________ # ________________________
GENDER_____
$6.00 SPAYED/NEUTERED $50.00 MALE/FEMALE (3 months or older)
DOG NAME_____________ TAG#_____________ BREED____________ $30.00 SPAYED/NEUTEREDGENDER_____
COLOR____________
• OVER 65 YEARS OLD (senior citizens / disabled) •OVER 65 YEARS OLD (senior citizens / disabled)
$6.00 MALE/FEMALE (3m or older) $30.00 MALE/FEMALE (3m or older)
$4.00 SPAYED/NEUTERED $20.00 SPAYED/NEUTERED
A permanent identification verification form must be accompanied before the license will be issued.
Renewal, New or additional Licenses & Paperwork Questions CHECKS PAYABLE TO CITY TREASURER
DOG LICENSE - 626 State St – Room 105, Erie PA 16501 SUBMIT APPLICATIONS* TO:
8:30 AM – 4:00 PM Phone 814-870-1210
Lost & Found Animal Questions CITY TREASURER’S OFFICE
626 STATE ST ROOM 105 - Erie, PA 16501
HUMANE SOCIETY OF NW PA
2407 Zimmerly Rd – Erie PA 16506 - 814-835-8331 Cash Check # ________ Receipt # ___________
Name on Check _____________________Clerk ______
Animal Complaints A $30 FEE WILL BE IMPOSED FOR ALL RETURNED CHECKS
ANIMAL ENFORCEMENT - 626 State St. - Rm 111- Erie PA 16501 * IF MAILING YOUR APPLICATION, YOU MUST INCLUDE A SELF-
814-870-1136 Leave Message or 814-870-1125 ADDRESSED, STAMPED ENVELOPE TO RECEIVE YOUR LICENSE.
Cash
Michael Haas
Check # ________
509 Cranberry Street
Receipt # _____________
ERIE,
ClerkPA 16507 ________________________
Signature
Lifetime License Information
The owner of any dog three months of age or older which has been permanently identified (MICRO CHIPPED) may apply for a lifetime license for such
a dog. Except as otherwise provided in this act, a dog which has been issued a lifetime license shall be required to wear a license tag. The application and
license certificate shall state the breed, sex, age, color and markings of such dog, the type and number of permanent identification and the name, address and
telephone number of the owner. A permanent identification verification form must be accompanied before the license will be issued. The application shall be
accompanied by the appropriate license fee as follows:
• For each neutered male dog and for each spayed female dog for which the certificate of a licensed doctor of veterinary medicine or the affidavit of
the owner is produced, the lifetime license fee shall be $30.
• For all other male and female dogs, the license fee shall be $ 50.
• For Pennsylvania residents 65 years of age or older and/or persons with disabilities:
o For each neutered male dog and for each spayed female dog for which the certificate of a licensed doctor of veterinary medicine or the
affidavit of the owner is produced, the license fee shall be $20.
o For all other male and female dogs, the license fee shall be $30.