McKean County, Pennsylvania

McKean County Treasurer                                                                                     

All fields are required. Licenses issued today expire on 12/31/2014.                                                                                                 Comments or Questions?
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     PA Department of Agriculture, Bureau of Dog Law Enforcement         April 25, 2014     1:10 AM
     DOG LICENSE APPLICATION

      First Name   Last

              Street

                 City    State      Zip -

               Email   Phone ( ) -

       Township   Birth Date / /
                                                                                                                        mm/dd/yyyy

            BIRTH DATE REQUIRED IF PURCHASING A SENIOR LICENSE (age 65). APPLICANTS FOR SENIOR OR
      DISABILITY LICENSE MUST HAVE PROOF OF AGE OR DISABILITY ON FILE WITH THE COUNTY TREASURER.

                  I hereby verify that I am the owner of the described dog and all information provided on this
                    application is true and correct. I make this statement subject to the Criminal Penalties of
                                18 Pa. C.S. section 4904 (Relating to unsworn falsification to authorities.)

                              Signature

                       License Type

         Dog Name      Breed

                    Age                                          Color

                                                     

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