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2. Animal Licensing Application
   Firestone residents who own dogs and cats must license them annually through the Firestone Police Department. All pets must have current proof of rabies vaccination before a license will be issued.
4. This application is:

   1. New

   1. Renewal
6. OWNER INFORMATION
8. Animal Owner's First Name:*
9. Animal Owner's Last Name:*
11. Email Address:*
13. Physical Address:*
14. P.O. Box (if applicable):
16. Phone Number:*
    (please give a phone number that we can reach if we have an emergency with your pet)
17. Alternate Emergency Phone Number:
21. VETERINARIAN INFORMATION
23. Veterinarian Name:
24. Veterinarian Phone Number:
26. Veterinarian Address, City, State, Zip Code
30. PET INFORMATION
32. Animal Name:*
33. Species:*

    1. Dog
    2. Cat
34. Gender:*

    1. Male
    2. Female
36. Breed:*
37. Microchip ID brand and number:
39. Identifying colors or markings:
41. Is your pet current on vaccination for Rabies?*

    1. Yes
    2. No

    This is a requirement and this information will need to be verified prior to receiving your pet license.
42. Rabies Certificate Tag Number:*
43. Date of Vaccination:*
    Date of Vaccination:
45. Vaccination length:*

    1. 1 year

    1. 3 years
46. Upload copy of Rabies Certificate*
48. Do you currently have a Firestone Smart Tag License?

    1. Yes

    1. No
49. Do you need a replacement tag?

    1. Yes

    1. No
51. LICENSING FEES:
52. Is your pet altered? (select one)*

    1. Spayed/Neutered - $5.00

    1. Unaltered - $10.00
54. Animal License
    Animal License
55. Taxable
56. Quantity
57. Shipping Cost
61. PET INFORMATION
63. Animal Name:
64. Species

    1. Dog
    2. Cat
65. Gender

    1. Male
    2. Female
67. Breed:
68. Microchip ID brand and number:
70. Identifying colors or markings:
72. Is your pet current on vaccination for Rabies?

    1. Yes
    2. No

    This is a requirement and this information will need to be verified prior to receiving your pet license.
73. Rabies Certificate Tag Number:
74. Date of Vaccination:
    Date of Vaccination:
76. Vaccination length:

    1. 1 year

    1. 3 years
77. Upload copy of Rabies Certificate
79. Do you currently have a Firestone Smart Tag License?

    1. Yes

    1. No
80. Do you need a replacement tag?

    1. Yes

    1. No
82. LICENSING FEES:
83. Is your pet altered? (select one)

    1. Spayed/Neutered - $5.00

    1. Unaltered - $10.00
85. Animal License
    Animal License
86. Quantity
87. Shipping Cost
88. Taxable
92. PET INFORMATION
94. Animal Name:
95. Species

    1. Dog
    2. Cat
96. Gender

    1. Male
    2. Female
98. Breed:
99. Microchip ID brand and number:
101. Identifying colors or markings:
103. Is your pet current on vaccination for Rabies?

     1. Yes
     2. No

     This is a requirement and this information will need to be verified prior to receiving your pet license.
104. Rabies Certificate Tag Number:
105. Date of Vaccination:
     Date of Vaccination:
107. Vaccination length:

     1. 1 year

     1. 3 years
108. Upload copy of Rabies Certificate
110. Do you currently have a Firestone Smart Tag License?

     1. Yes

     1. No
111. Do you need a replacement tag?

     1. Yes

     1. No
113. LICENSING FEES:
114. Is your pet altered? (select one)

     1. Spayed/Neutered - $5.00

     1. Unaltered - $10.00
116. Animal License
     Animal License
117. Quantity
118. Shipping Cost
119. Taxable
123. A nonrefundable convenience fee for all online transactions will be added upon checkout.
125. Check Here*

     1. I agree my electronic submission of this form constitutes my signature affirming the above information is true and correct.
127. Signature*
128. Date*
     Date
Leave This Blank:


129. Calculate Totals Proceed to Checkout

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