2020 DOG LICENSE APPLICATION & INFORMATION WI STATUTES

Dog License Applications

2020 DOG LICENSE APPLICATION & INFORMATION

WI Statutes §174.05 & §95.21 provide that all dogs over 5 months of age shall be licensed and vaccinated.
All licenses expire on December 31, and must be renewed no later than March 31 of the following year.
No license shall be issued without proof that the dog has been vaccinated.
To obtain a license, please bring when you pay taxes or mail ALL of the following items to

Treasurer Town of Roxbury, 9464 Cty Rd Y, Sauk City, WI 53583

1. Current Certificate of Vaccination for each dog. This will be returned with your license(s). Service

invoices are not acceptable proof. Veterinarians must provide a Certificate of Vaccination.

2. Exact check (separate from your tax check) made payable to “Town of Roxbury” or exact cash. DO NOT MAIL CASH.

3. Completed Dog License Application (see below). Incomplete applications cannot be processed.

4. Self-addressed, 4’ X 9” stamped envelope with adequate postage. If you license 3 or more dogs, extra postage is required. If you fail to enclose a SASE, your dog license tag CANNOT be forwarded to you. You will then need to contact Nanette Backeberg at 643-6204 to set up a time to pick up the dog license tag.

Dog licenses will NOT be processed while collecting taxes.

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**Don’t forget a self-addressed, stamped envelope with adequate postage**

DOG LICENSE APPLICATION

Owner Last Name

Owner First Name

Phone

Address

City

Zip

Dog Information

Dog 1

Dog 2

Dog 3

Dog 4

Name

Breed

Color

Vacc Due Date

New  Renew



New  Renew



New  Renew



New  Renew



$ 16.00 Spayed F



$ 16.00 Spayed F



$ 16.00 Spayed F



$ 16.00 Spayed F



$ 16.00 Neutered M



$ 16.00 Neutered M



$ 16.00 Neutered M



$ 16.00 Neutered M



$ 21.00 Female



$ 21.00 Female



$ 21.00 Female



$ 21.00 Female



$ 21.00 Male



$ 21.00 Male



$ 21.00 Male



$ 21.00 Male



OFFICE USE ONLY BELOW THIS LINE

Vaccination Certificate _________

Dog License Fee $_____________

Dog 1 License Tag # ___________

Dog 2 License Tag # ___________

Dog 3 License Tag # ___________

Dog 4 License Tag # ___________

When stamped “paid” by the Town of Roxbury this will serve as your receipt. Licenses issued in 2020 are valid until December 31, 2020.

MULTIPLE DOG LICENSE APPLICATION

Business Name

FEIN

Business Owner Last Name:

Owner First Name

Phone

Address

City

Zip

New Issue



Number of dogs

Renew



Name of Veterinarian

Veterinarian Phone

Dog 1

Dog 2

Dog 3

Dog 4

Name

Breed

Color

Vacc Due Date

New  Renew



New  Renew



New  Renew



New  Renew



Spayed F



Spayed F



Spayed F



Spayed F



Neutered M



Neutered M



Neutered M



Neutered M



Female



Female



Female



Female



Male



Male



Male



Male



Dog 5

Dog 6

Dog 7

Dog 8

Name

Breed

Color

Vacc Due Date

New  Renew



New  Renew



New  Renew



New  Renew



Spayed F



Spayed F



Spayed F



Spayed F



Neutered M



Neutered M



Neutered M



Neutered M



Female



Female



Female



Female



Male



Male



Male



Male



Dog 9

Dog 10

Dog 11

Dog 12

Name

Breed

Color

Vacc Due Date

New  Renew



New  Renew



New  Renew



New  Renew



Spayed F



Spayed F



Spayed F



Spayed F



Neutered M



Neutered M



Neutered M



Neutered M



Female



Female



Female



Female



Male



Male



Male



Male



OFFICE USE ONLY BELOW THIS LINE

License Fee: $ ______________

$75.00 for the first 1-12 dogs,

$16.00 for each dog thereafter.

Number of Tags Issued: _________

First Tag in Sequence _________

Last Tag in Sequence _________

When stamped “paid” by the Town of Roxbury this will serve as your receipt. Licenses issued in 2020 are valid until December 31, 2020.

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