Spay/Neuter Voucher Application

Montgomery County Friends of Animal Care and Control

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Montgomery County Friends of Animal Care and Control offer a Spay/Neuter Voucher, based on financial need. This voucher is for Spay/Neuter surgeries at Mountain View Humane and is valid for Montgomery County residents only.

The voucher will cover the entire cost of the procedure for pets under 60 lbs. There is a small fee for pets over 60 lbs. that you may incur from Mountain View Humane.

It takes approximately 5 business days to review your application and we will contact you regarding the voucher. Each househould can apply for a maximum of 2 vouchers (limit 2 pets). An individual application must be submitted per pet. If you have more than 2 pets in your household, we ask that you get female pets spayed first.

Please complete and submit this application for review.

APPLICANT INFORMATION
First Name *
Last Name *
Street Address *
City/Town of Residence *
State *
Zip Code *
Home Phone
Cell Phone
Work Phone
Email Address
Select program(s) that apply to your household:	SNAP Benefits Medicaid TANF SSI
Number of People in Household
Applicant's Employer
Applicant's Gross Annual Salary
Spouse's Employer
Spouse's Gross Annual Salary
Please list all other sources of monthly income (Disability, Child Support, Alimony, etc.)
PET INFORMATION
Pet Name
Pet Species	Dog Cat
Pet Sex	Male Female
Pet Approx. Age
Is your pet up-to-date on Rabies Vaccination?
Is your pet microchipped?
FOR DOG ONLY
Breed
Weight
ADDITIONAL INFORMATION
Comments
ACKNOWLEDGEMENT
I attest that the information provided is current and correct.
Date *
Signature *

Spay/Neuter Voucher Application

Montgomery County Friends of Animal Care and Control

APPLICANT INFORMATION

PET INFORMATION

FOR DOG ONLY

ADDITIONAL INFORMATION

ACKNOWLEDGEMENT