EmailMe Form - TERRE HAUTE PET LICENSE APPLICATION

TERRE HAUTE PET LICENSE APPLICATION

This form is for residents of the City of Terre Haute only. All dogs and cats over the age of three (3) months owned by residents of the City of Terre Haute must be registered per City Code Section 6-71

Complete the form and attach a photo of your dog or cat's current rabies vaccination form. Only one animal may be registered per form.

All fields marked with an asterisk (*) are required to be completed.

You will be contacted by email if there are any issues with your submission. If no response from our email, we will try to contact you by telephone.

-------------------------------OWNER'S INFORMATION-------------------------------
Your name *
First MI Last
Address. No PO Boxes. Must be a Terre Haute address *

Street Address City State / Province / Region Postal / Zip Code
Phone *
### - ### - ####
Email *
Alternate Contact Name
First MI Last
Only complete if you wish to add an additional individual to be contacted. This individual will not be considered a registered owner of the dog or cat.
Alternate Phone
### - ### - ####
You may enter an alternative telephone number for yourself or if you listed an alternate contact, please list their telephone number.
Delivery method of approved license form *
Please indicate whether you would like your pet license form to be emailed to you or sent by US Mail
------------------------------ANIMAL'S INFORMATION-------------------------------
Animal's name *
Color/marking of animal *
Examples would be white, brown, tan, black, tri-color black/white/brown, white with black markings, black with white markings.
Type of Animal *
Animal Gender *
Status of animal *
Age of animal *
Rabies Vaccination form from veterinarian *
At this time we can only accept Jpg, Tif, Png, or PDF file
You may attach a photo of your pet
Any photo you attach of your pet would be used in case your pet becomes lost. Please limit file size to 2MB

At this time we can only accept Jpg, Tif, Png, or PDF file
Microchip information
If your animal is microchipped you may list the number here. It would be used if your animal becomes lost
Type of License *
Please select which license you are submitting an application for.
COURT CITATIONS *

I understand that if I or a member of my household have been cited for a violation that relates to this application, submission of application does not cancel the court hearing. I must attend the court hearing or contact the City of Terre Haute Legal Department at least two (2) business days prior to the court hearing after application is approved.
Final review terms *

You will be contacted, after final review, if it is found you have registered more than six (6) dogs, six (6) cats or combination for one household. Your pet license will be voided. Your payment may not be refunded.
Payment required

Please visit www.TerreHauteCityCourtPayments.com for payment submission after submitting form. You will select PERMITS AND LICENSE button

-------------------------------OWNER'S INFORMATION-------------------------------

------------------------------ANIMAL'S INFORMATION-------------------------------