Affidavit of Death/Lost or Stolen Dog

By signing and submitting this form you are declaring that the following information is true and accurate.

Owners Name*

Phone*

Owners Address*

City*

State*

Zip*

Name of Dog and Tag Number if you have it

I declare that my dog*

is deceased

is lost/stolen/ran away

is no longer in my possession. My Veterinarian’s Office/SPCA/Other has taken responsibility of my dog.

is buried on land.

Approximate Date of Death or Loss/Stolen/Possession of your Dog.

Proof of creamatin/euthanasia must be provided to cancel dog license

Drop files here or

Max. file size: 64 MB, Max. files: 1.

Signature*

Date*