La Canada/Flintridge
Dog License Application

Print & submit a completed copy of this form and payment to:
Pasadena Humane Society, 361 S. Raymond Ave, Pasadena 91105 Attn. Licensing Dept
Questions? Call 626-792-7151 x115

Dog's Name: ________________________________________
Breed: _________________________  Pure Breed   Mixed Breed
Color: _________________________ Markings: ___________________________

Microchip #: _____________________________
Age: ____ years ____ months (must be at least 4 months of age to be licensed) 
Size:   Small   Medium   Large
Please check one:
 Female (not spayed)
Female Spayed
Male  (not neutered)
Male Neutered 


____________________________________________
Owner's First Name                     Last Name

_______________________________________________________________
Address        

City: __LA CANADA_______ State _CA___ Zip _91011_

Telephone Number: ___________________ 

This is for a: Renewal or   New License

  • You must submit a copy of a current rabies certificate with this application.  Rabies vaccination certificate must be good throughout the license period. (LCFMC 10.20.220)
  • If applying for senior discount on a new license, you must submit proof of age (60+ years). (LCFMC 10.20.035)
  • If applying for spay/neuter discount on a new license, you must submit certificate of sterility. (LCFMC 10.20.110)
  • License period is 12 months from date of issue.

DOG LICENSE FEES ** NEW PRICES AS OF 9/1/2004 **

Resident
Dog Unaltered $30
Spayed/Neutered $15
______________
Senior Citizen
(must show proof of 60 years +)
Dog Unaltered $15
Spayed/Neutered $5
______________
Late Renewal Charge (if 30 or more days late)
$25
______________
Engraving dog's name & phone number on back of license (NEW licences only): ___________________________________
$5
______________
Total $ ____________

PLEASE MAKE CHECKS PAYABLE TO: PHS

Thank you!