EmailMe Form - 2023 Henderson Dog License

Pet Owner's Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Email

Phone *

### - ### - ####

Name of Dog *

Expiration Date of Rabies Shot *

MM / DD / YYYY

Sex of Dog *

Female

Male

Neutered/Spayed

Dog Breed (check all that apply) *

*Other breed if not listed above

Specific Breed (check all that apply)

Color of Dog (check all that apply) *

Further Description of Dog (if necessary)

Upload Picture of Dog

Acknowledgment of Dog Waste Ordinance *

I hereby acknowledge it is unlawful for any dog to discharge feces or manure on public property or private property of another unless it is promptly removed by the person having custody or control of the dog and disposed of in a sanitary manner.

Acknowledgment of Leash Ordinance *

I hereby acknowledge no dog is allowed to run at large. All dogs need to be on a leash, tied up or in a fence and the dog license attached to the collar.

Acknowledgment of Maximum Number of Dogs Ordinance *

I hereby acknowledge there is a limit of a maximum of three (3) dogs per household over the age of three (3) months.

City of Henderson Dog Fee ($5) *

$ Dollars

State of Nebraska Dog Fee ($1) *

$ Dollars

By typing your name below, you hereby acknowledge the above information to be true. *