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ZrIaLml I � I I <br />SUbM!t to (devolver a): <br />3050 N Detta Hwy, Eugene, Oregon 97408 / (541) 682-3645 <br />New 0 Renew No. 0 Replace only = $2,00 (no charge if renewing <br />e _ _... <br />Owner Name`, r <br />Nombre Del Duefio '3o so 0- k <br />First(l Nambre <br />Address: <br />C)CL <br />Direccil5n de su hogar: <br />State dip <br />Mailing Address- <br />Direcci6n pare el correo: <br />state Zip <br />Phone #: Message Phone # <br />TeWol TeWolno pare I s Lie <br />Tlhis application is for dog owners that five in unincorpol Lane Coun�y oniy, <br />CiW of Eugene- residents, cardact EugeneAnimal Control forinforniation. 541-687-4060 <br />Sterile,'EstiW: <br />$15-00 <br />Dog Name: Broad: Color. <br />Nombre de perro. Roza: i2L_L_ Colorer: __L Colo I �eI(L61 1 "i <br />I I <br />Spay"Nouter *Yes 0 N <br />Fernier` FI�rtij - S r. r° itizen 0* er Ls 65 or older): <br />Gander 0 Male 0 Female Castrado? 0 Si () No <br />Age: <br />Edad: <br />Saxo* 0 Masculino 0 Ferninina Must provide proof <br />Persona de In teraera edad (etas de 85 zibos): <br />(Prueba de castrado nel <br />$55.00 <br />L <br />Rabies Expiration Date. '�-- k - _2CA%1 . 15 Tag Number : Iq -7 <br />(Expiraci6n de is vacuns de rabia): MWE)DIMY (Nurnero de rabia) <br />Vet CHnIcName: 7,77�1 77 TE,.( _C\ 1 1� <br />(Nombre de Veterinario/Clinlca)_ <br />ii 10 , <br />m <br />Persona de la tercera edad <br />Does the dog have a microchip? 0 Yes 0 Na <br />0 _Si C7 NO <br />3! yes <br />Z '­.. — in fill <br />Fertile/Fktil: <br />$35.00 <br />$55-00 <br />$7 .00 <br />Sterile,'EstiW: <br />$15-00 <br />$25.00 <br />$35. <br />__) <br />Fernier` FI�rtij - S r. r° itizen 0* er Ls 65 or older): <br />Persona de In teraera edad (etas de 85 zibos): <br />$35,00 <br />$55.00 <br />$70-00 <br />Sterfle/Est6ril -Sr. Citizen (ovill is 65 or older): <br />Persona de la tercera edad <br />