Town of Amherst

2021 DOG LICENSE APPLICATION

. Town of Amherst / Portage County 2021 Dog License Notice/Application ALL dogs over the age of 5 months must be vaccinated for rabies and licensed under WI SS# 174-05. The Town Treasurer will at the Municipal Building (4023 County Road Q, Amherst Junction) on the 2nd Wednesday of each month (town board meeting dates) from 5:00 p.m. to 6:00 p.m. Late fee of $5.00 per dog applied beginning April 1, 2021 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ For each license requested, the following is required: Current Rabies Vaccination certificate Proof of spay/neuter License fees (payable to Town of Amherst) Jan. 1 through March 31 April 1 through December 31 Owner’s Name _______________________________ Male Neutered = $12.00 _______ $17.00 _____ Dog’s Name _______________________________ Male Non-Neutered = $24.00 _______ $29.00 _____ Breed: _______________________________ Female Spayed = $12.00 _______ $17.00 _____ Color: _______________________________ Female Non-Spayed = $24.00 _______ $29.00 _____ Date of Rabies shot: _______________________________ Expiration:_________________(include copy of certificate) To license by mail, send the above information and a self-addressed, stamped envelope to: Amherst Town Treasurer 4023 County Road Q PO Box 5 Amherst Junction, WI 54407 (Please make copies of this form as needed)