Deceased/Lost Dog Affidavit

By signing and submitting this affidavit you are declaring the information is true and accurate.

Name *

First

Last

Email *

Phone *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

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

Click or drag a file to this area to upload.

Signature *