Form Center

2. Owner Information
4. Name*
5. Email Address
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
17. Pet Information
19. Pet Type*

    1. Dog
    2. Cat
21. Name of Dog / Cat*
23. Color 1*
    -- Select One --ApricotApricot StripedBeigeBlackBlack Brown BrindleBlueBlue - DarkBrownBrown - DarkBrown - Dark StripedBrown - LightBrown - Light StripedBrown StripedBrown TabbyBuffCalicoChestnutChocolateCreamCream TabbyFawnGoldGold DottedGold StripedGrayGray TabbyHarlequinLilacLiverMerle BlueMerle RedOrangeOrange DottedOrange TabbyRedRed - DappleRed - DottedRed TabbyRoanRustSeal PointSilverSilver - LightTanTan StripedTiger StripeTorbieTortoiseshellTricolorWheatenWhiteWhite DottedYellow
24. Color 2
    -- Select One --ApricotApricot StripedBeigeBlackBlack Brown BrindleBlueBlue - DarkBrownBrown - DarkBrown - Dark StripedBrown - LightBrown StripedBrown TabbyBuffCalicoChestnutChocolateCreamFawnGoldGold DottedGold StripedGrayGray TabbyHarlequinLilacLiverMerle BlueMerle RedOrangeOrange DottedOrange TabbyRedRed - DappleRed DottedRed TabbyRoanRustSeal PointSilverSilver - LightTanTan StripedTiger StripeTorbieTortoiseshellTricolorWheatenWhiteWhite DottedYellow
25. Color 3
    -- Select One --ApricotApricot StripedBeigeBlackBlack Brown BrindleBlueBlue - DarkBrownBrown - DarkBrown - Dark StripedBrown - LightBrown - Light StripedBrown StripedBrown TabbyBuffCalicoChestnutChocolateCreamCream TabbyFawnGoldGold DottedGold StripedGrayGray TabbyHarlequinLilacLiverMerle BlueMerle RedOrangeOrange DottedOrange TabbyRedRed - DappleRed DottedRed TabbyRoanRustSeal PointSilverSilver - LightTanTan StripedTiger StripeTorbieTortoiseshellTricolorWheatenWhiteWhite DottedYellow
27. Breed*
29. Sex*

    1. Male
    2. Female
30. Is your pet spayed/neutered?*

    1. Yes
    2. No
34. Rabies Shot Information
36. Date of Shot*
    Date of Shot
37. Expiration Date*
    Expiration Date
39. Vaccine Manufacturer*
40. Serial Number*
42. Vet Clinic*
44. License Fees

    All fees are per animal. Please fill out a form for each animal.

46. Cat
    • Duplicate - $0.00
    • Female - $11.00
    • Female Spayed - $6.00
    • Male - $11.00
    • Male Neutered - $6.00
    • Service - $0.00
    • Late Fee - $5.00
47. Dog
    • Duplicate - $0.00
    • Female - $11.00
    • Female Spayed - $6.00
    • Male - $11.00
    • Male Neutered - $6.00
    • Dog Park (City) - $20.00
      (After 06/30 - $10.00)
    • Dog Park (County) - $28.00
      (After 06/30 - $14.00)
    • Service - $0.00
    • Late Fee - $5.00
49. Payment Instructions

    Please make sure you send a check with a self-addressed stamped envelope to:

    City of Menomonie
    800 Wilson Ave
    Menomonie, WI 54751

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50. Print Only

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