DOG LICENSE APPLICATION
City of Happy Valley
16000 SE Misty Drive
Happy Valley, Oregon 97086
Phone: 503-783
-3800 Fax: 503-658-5174
www.happyvalleyor.gov
Ordinance No. 362, Effective Date: January 1, 2008
New HV License Renewal HV License License # ______________________
(*A copy of your current dog license from another agency and/or jurisdiction must be attached to be exempt from paying Happy Valley fee. *)
Name ____________________________________________________________________________________
Address ___________________________________ City _____________ State ___________ Zip ___________
Primary Phone ______________________________________ Other Phone ____________________________
Email Address ______________________________________________________________________________
Dog’s Name __________________________________________ Male Female
Breed _________________________________ Color/Markings ______________________________________
Spayed/Neutered? Yes No Microchip # _________________________________________
Rabies Expiration Date _______________________________________________________
(*Must attach proof of rabies vaccination and spay/neuter for license to be valid.
RABIES VACCINATIONS MUST BE VALID FOR THE ENTIRE LICENSING PERIOD.)
Vet Clinic Name ______________________________________ Vet Clinic Phone # ______________________
Please choose one of the
following FEES
Senior Citizen
Discount if Age 62+
Senior Citizen
Discount if Age 62+
$10 Replacement Metal Tag $25 NSF Check Returned
FOR STAFF USE ONLY: DATE RECEIVED:
License # _________________ Expires ____________ Amount Paid _____________
Cash _________ Check # ____________ CC __________ Receipt # ______________
Staff Signature ___________________________ Add to Walk List _______________
