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For a service dog. 2. The applicant fills out Part I (Applicant and Dog Information) and, if the dog is prescribed for the owner, the healthcare practitioner prescribing the dog fills out Part II. 3. The applicant submits the completed form to the Municipal Clerk when licensing the dog. 4. A properly filled-out and signed form is verifiable written evidence required by Municipal Clerks licensing a dog as a service dog. 5. The form is required for initial verification for waiver of the dog.

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