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JOHN K. WEINSTEIN Allegheny County Treasurer Annual dog licenses are valid from January 1st through December 31st of each year. If you wish to purchase a current year dog license please follow these simple steps 1. Complete and sign this application and mail along with check or money order. 2. If you are applying for a spayed or neutered dog you must submit written verification from licensed doctor of veterinary medicine or a written affidavit. 3. Make your check or money order payable to John K. Weinstein Room 109 Courthouse 436 Grant Street Pittsburgh PA 15219-2497 Note If you wish you may mail this application in the same envelope with your real estate tax payment. If you do so please write a separate check for each. Thank you for licensing and protecting your dog License DATE Year of license DOG LICENSE APPLICATION DOG S NAME DOG S AGE BREED ALL PRICES INCLUDE SERVICE FEE ALLOWED BY LAW* REGULAR FEE MALE COLOR OF DOG NEUTERED SPOTTED PERSON WITH DISABILITY OR SENIOR CITIZEN FEE FEMALE SPAYED WHITE BLACK BROWN OTHER--INDICATE If the license is issued by an agent of the COUNTY TREASURER an additional 50 will be charged* PLEASE NOTE IF YOU ARE APPLYING FOR A LICENSE THAT REQUIRES THE DOG OWNER TO BE A SENIOR CITIZEN AGE 65 OR OLDER OR A PERSON WITH DISABILITY YOU MUST PROVIDE PROOF OF AGE OR DISABILITY TO THE COUNTY TREASURER OR AGENT. OWNER S NAME TELEPHONE NO. OWNER S BIRTH DATE MO. DAY YR* STREET OR R*D. NO. CITY TOWNSHIP/BOROUGH STATE ZIP CODE PA I HEREBY VERIFY THAT I AM THE OWNER OF THE DOG THAT IS THE SUBJECT OF THIS DOG LICENSE APPLICATION* I MAKE THIS STATEMENT SUBJECT TO THE CRIMINAL PENALTIES OF 18 Pa* SECTION 4904 RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES. SIGNATURE OF DOG OWNER/APPLICANT REQUIRED MAIL TO COUNTY TREASURER S OFFICE ALL FEES ARE ESTABLISHED BY THE COMMONWEALTH OF PENNSYLVANIA. If you wish to purchase a current year dog license please follow these simple steps 1. Complete and sign this application and mail along with check or money order. 2. If you are applying for a spayed or neutered dog you must submit written verification from licensed doctor of veterinary medicine or a written affidavit. 2. If you are applying for a spayed or neutered dog you must submit written verification from licensed doctor of veterinary medicine or a written affidavit. 3. Make your check or money order payable to John K. Weinstein Room 109 Courthouse 436 Grant Street Pittsburgh PA 15219-2497 Note If you wish you may mail this application in the same envelope with your real estate tax payment. 3. Make your check or money order payable to John K. Weinstein Room 109 Courthouse 436 Grant Street Pittsburgh PA 15219-2497 Note If you wish you may mail this application in the same envelope with your real estate tax payment. If you do so please write a separate check for each. Thank you for licensing and protecting your dog License DATE Year of license DOG LICENSE APPLICATION DOG S NAME DOG S AGE BREED ALL PRICES INCLUDE SERVICE FEE ALLOWED BY LAW* REGULAR FEE MALE COLOR OF DOG NEUTERED SPOTTED PERSON WITH DISABILITY OR SENIOR CITIZEN FEE FEMALE SPAYED WHITE BLACK BROWN OTHER--INDICATE If the license is issued by an agent of the COUNTY TREASURER an additional 50 will be charged* PLEASE NOTE IF YOU ARE APPLYING FOR A LICENSE THAT REQUIRES THE DOG OWNER TO BE A SENIOR CITIZEN AGE 65 OR OLDER OR A PERSON WITH DISABILITY YOU MUST PROVIDE PROOF OF AGE OR DISABILITY TO THE COUNTY TREASURER OR AGENT. .

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