New Owner's Information
First name:
Last name:
Street address:
City:
State:
Zip code:
Driver's license or Identification #:
Cell number:
Home phone:
Animal Information
Animal Name:
Ainsley (Cat - 2452254)
Arthur (Cat - 2452224)
Arvo (Dog - 2452315)
Bardo (Dog - 2452312)
Bell Pepper (Cat - 2452371)
Bellatrix (Cat - 2137068)
Belle (Cat - 2451985)
Bob (Dog - 2452320)
Bondi (Dog - 2452316)
Bryce (Cat - 2451622)
Buffy (Dog - 2451917)
Bug (Cat - 2452274)
Burkley (Cat - 2452096)
Carrot (Dog - 2452369)
Celery (Dog - 2452128)
Charmander (Cat - 2452306)
Chikorita (Cat - 2452307)
Chili (Cat - 2452063)
Chunkers (Dog - 2451906)
Clove (Dog - 2452122)
Comet (Cat - 2452310)
Cool Ranch (Cat - 2452066)
Copito (Dog - 2452351)
Crow (Cat - 2452217)
Cucumber (Dog - 2452370)
Cujo (Dog - 2452222)
Dell (Cat - 2452135)
DiDi (Dog - 2451905)
Dorothy (Cat - 2452106)
Duck (Cat - 2451981)
Duke (Dog - 2452374)
Eeyore (Dog - 2451942)
Eleanor (Cat - 2452273)
Elizabeth 4 (Cat - 2452210)
Elizabeth 5 (Cat - 2452211)
Elizabeth 6 (Cat - 2452212)
Erly (Dog - 2452144)
Fiamma (Cat - 2345410)
Free Range (Dog - 2452119)
Furrnin (Cat - 2452179)
Galloway (Dog - 2451908)
Goose (Cat - 2451979)
Gracie (Dog - 2451571)
Hodge (Dog - 2452036)
Isla (Dog - 2452317)
Jinks (Dog - 2452029)
Joe Bob (Cat - 2345220)
Joey (Dog - 2452313)
Kiyo (Cat - 2451988)
Land-in (Dog - 2452134)
Larry (Cat - 2452071)
Lemondrop (Dog - 2452267)
Lily (Dog - 2452321)
Macey (Dog - 2452338)
Maroney (Dog - 2452099)
Mary (Cat - 2451926)
Midnight (Cat - 2452105)
Minnie (Cat - 2452353)
Misky (Cat - 2452032)
Modok Alfredo (Dog - 2452305)
Musketeer (Dog - 2452270)
Ninja (Cat - 2452030)
Onion (Cat - 2452373)
Pawtricia (Dog - 2451937)
Penny (Dog - 2452350)
Pepper (Cat - 2452062)
Pluto (Cat - 2449268)
Pro Star (Dog - 2452349)
Pumpkin Spice (Dog - 2452123)
Queen (Dog - 2452065)
Radish (Cat - 2452372)
Raven (Cat - 2452216)
Roo (Dog - 2452314)
Rubble (Dog - 2451322)
Sasha (Cat - 2452272)
Sienna (Dog - 2452318)
Skittle (Dog - 2452268)
Spider (Cat - 2452276)
Spot (Dog - 2452052)
Swan (Cat - 2451978)
Taffy (Dog - 2452266)
Ten Piece (Dog - 2451907)
Test Blah (Dog - 2452271)
Tony (Cat - 2452352)
Totino (Cat - 2451761)
Werther (Dog - 2452265)
Whopper (Dog - 2452264)
Zhru (Dog - 2352306)
butterfinger (Cat - 2452295)
crunch (Cat - 2452296)
kit kat (Cat - 2452294)
Color:
Agouti
Black
Black and Brindle
Black and Brown
Black and Grey
Black and Tan
Black and White
Black brown and orange
Black, Brown, and White
Black, Brown, Merle
Black/Orange/White
Black, Tan, White
Black/White/Gray
Black/white/Orange
Black, White, & Tan
Blonde
Blue
Blue and Tan
Blue and White
Blue Brindle
Blue Merle
Brindle
Brindle and Black
Brindle and Brown
Brindle and White
Brindle/Black/White
Brown
Brown and Black
Brown and Tan
Brown and White
Brown Black and white
Brown, Green, & Blue
Brown & Grey
Brown Tan and White
Brown White and Black
Calico
Champagne
Champagne & White
Chocolate
Chocolate and Tan
Chocolate and White
Chocolate Merle
Cinnamon
Cream
Cream and Black
Cream and Brown
Cream and White
Cream, Brown, White
Dapple
Fawn
Flame Point
Ginger
Ginger and White
Golden
Gray and Brown
Green
Grey
Grey and Black
Grey and Black and White
Grey and White
Grey, Black & Brown
Grey/Black/Orange
Grey, Brindle
Grey, Brindle, White
Harlequin
Light Brown
Lilac
Lilac & Tan
Lilac Tortie
Liver
Liver and White
Lynx Point
Merle
Merle and White
Orange
Orange and Grey
Orange and White
Orange/Black/White
Orange/White/Black
Red
Red Agouti
Red and black
red and brown
Red and White
Red, Black, White
Red, White & Blue
Sable
Sable and White
Seal Brown
Silver
Silver Agouti
Sorrel
Tabby
Tabby and White
Tabby / Calico
Tan
Tan and Black
Tan and Brown
Tan and Silver
Tan and White
Tan White and black
Tortie
Tortie and White
Tricolour
Unknown
Unknown
Various
White
White and Black
White and Blue
White and Brindle
White and Brown
White and Cream
White and Grey
White and Liver
White and Merle
White and Orange
White and Red
White and Tabby
White and Tan
White and Torti
White Black and Brown
White Black and Tan
white black merle
White/Black/Orange
white/brown/black
white brown black merle
White, brown, & tan
White/Orange/Black
White, Red, Black
Yellow
Yellow and Grey
Yellow and White
Breed:
Afghan Hound
Airedale Terrier
Akbash
Akita
Alaskan Malamute
American Bulldog
American Crested
American Eskimo dog
American Guinea Pig
Anatolian Shepherd
Armadillo
Australian cattle dog/Blue Heeler
Australian cattle dog/red heeler
Australian Kelpie
Australian Shepherd
Basenji
Basset Hound
Bat
Beagle
Bearded Collie
Beauceron
Belgian Malinois
Bengal
Bernese Mountain Dog
Bichon Frise
Black and Tan Coonhound
Black Labrador Retriever
Black Mouth Cur
Bloodhound
Blue-jay
Blue Lacy
Bluetick Coonhound
Boa
Bobcat
Bombay
Border Collie
Border Terrier
Boston Terrier
Boxer
Boykin Spaniel
British Shorthair
Brittany Spaniel
Bulldog
Bullmastiff
Bull Terrier
Cairn Terrier
Calico
Cane Corso
Cardinal
Carolina Dog
Catahoula Leopard Dog
Cavalier King Charles Spaniel
Chesapeake Bay Retriever
Chicken
Chihuahua
Chinese Crested Dog
Chiweenie
Chocolate Labrador Retriever
Chow Chow
Cockapoo
Cocker Spaniel
Collie
Coonhound
Corgi
Coyote
Crossbreed
Cur
Czech Shepherd
Dachshund
Dalmatian
Doberman Pinscher
Domestic Long Hair
Domestic Medium Hair
Domestic Short Hair
Dove
Dutch
English Bulldog
English Pointer
English Setter
Feist
Ferret
Fox
Foxhound
Fox Terrier
French Bulldog
Gecko
German Shepherd Dog
German Shorthaired Pointer
Golden Retriever
Goose
Great Dane
Great Pyrenees
Greyhound
Guinea Pig
Guinea Pig
Hamster
Havana
Havanese
Hawk
Himalayan
Hound
Hound mix
Husky
Irish Setter
Irish Wolfhound
Jack Russell Terrier
Japanese Chin
Kelpie
Labrador Mix
Labrador Retriever
Lacy
Lhasa Apso
Lionhead
Llewellin Setter
Maine Coon
Maltese
Manchester Terrier
Manx
Martin
Mastiff
Mastiff mix
Micro Bully
Miniature Aussie
Miniature Horse
Miniature Pinscher
Miniature Poodle
Miniature Schnauzer
Mix
Mockingbird
mole
Mountain Cur
Mountain Feist
mouse
Newfoundland
Norwegian Forest Cat
Opossum
Otterhound
Owl
Papillon
Parakeet
Parrot
Peacock
Pekingese
Persian
Pig
Pit Bull Terrier
Plott Hound
Pointer
Pomeranian
Poodle
Pot belly pig
Pug
Quarterhorse
Rabbit
Raccoon
Ragdoll
rat
Rat Terrier
Redbone Coonhound
Retriever
Rex
Rex
Rhodesian Ridgeback
Rott mix
Rottweiler
Russian Blue
Saint Bernard St. Bernard
Samoyed
Schipperke
Schnauzer
Scottish fold
Scottish Terrier Scottie
Setter
Shar Pei
Shepherd
Shetland Sheepdog Sheltie
Shiba Inu
Shih Tzu
Siamese
Siberian
Siberian Husky
Silky Terrier
Silver
Silver Fox
Silver Marten
Singapura
Skunk
Skunk
Skye Terrier
Sloughi
Smooth Fox Terrier
Snake
Snowshoe
Softbill (Other)
Somali
South Russian Ovcharka
Spaniel
Sphynx (hairless cat)
Spitz
Squirrel
Staffordshire Bull Terrier
Standardbred
Sugar Glider
Swan
Swedish Vallhund
Tabby
Tan
Tennessee Walker
Terrier
Texas Heeler
Thai Ridgeback
Thoroughbred
Tibetan Mastiff
Tibetan Spaniel
Tibetan Terrier
Tiger
Tonkinese
Tosa Inu
Toucan
Toy Fox Terrier
Treeing Tennessee Brindle
Treeing Walker Coonhound
Turkey
Turkish Angora
Turkish Van
Turtle
Turtle
Unknown
Unknown
Unknown
Vietnamese Pot Bellied
Vizsla
Vulture Black
Vulture Turkey
Warmblood
waterfowl
Waterfowl
Weimaraner
Welsh Corgi
Welsh Springer Spaniel
Welsh Terrier
West Highland White Terrier Westie
Wheaten Terrier
Whippet
White German Shepherd
white-tailed deer
Wire-haired Pointing Griffon
Wirehaired Terrier
Wolf Hybrid
Wolf Hybrid
Woodpecker
Xoloitzcuintle/Mexican Hairless
Yellow Labrador Retriever
Yorkshire Terrier Yorkie
Breed:
Afghan Hound
Airedale Terrier
Akbash
Akita
Alaskan Malamute
American Bulldog
American Crested
American Eskimo dog
American Guinea Pig
Anatolian Shepherd
Armadillo
Australian cattle dog/Blue Heeler
Australian cattle dog/red heeler
Australian Kelpie
Australian Shepherd
Basenji
Basset Hound
Bat
Beagle
Bearded Collie
Beauceron
Belgian Malinois
Bengal
Bernese Mountain Dog
Bichon Frise
Black and Tan Coonhound
Black Labrador Retriever
Black Mouth Cur
Bloodhound
Blue-jay
Blue Lacy
Bluetick Coonhound
Boa
Bobcat
Bombay
Border Collie
Border Terrier
Boston Terrier
Boxer
Boykin Spaniel
British Shorthair
Brittany Spaniel
Bulldog
Bullmastiff
Bull Terrier
Cairn Terrier
Calico
Cane Corso
Cardinal
Carolina Dog
Catahoula Leopard Dog
Cavalier King Charles Spaniel
Chesapeake Bay Retriever
Chicken
Chihuahua
Chinese Crested Dog
Chiweenie
Chocolate Labrador Retriever
Chow Chow
Cockapoo
Cocker Spaniel
Collie
Coonhound
Corgi
Coyote
Crossbreed
Cur
Czech Shepherd
Dachshund
Dalmatian
Doberman Pinscher
Domestic Long Hair
Domestic Medium Hair
Domestic Short Hair
Dove
Dutch
English Bulldog
English Pointer
English Setter
Feist
Ferret
Fox
Foxhound
Fox Terrier
French Bulldog
Gecko
German Shepherd Dog
German Shorthaired Pointer
Golden Retriever
Goose
Great Dane
Great Pyrenees
Greyhound
Guinea Pig
Guinea Pig
Hamster
Havana
Havanese
Hawk
Himalayan
Hound
Hound mix
Husky
Irish Setter
Irish Wolfhound
Jack Russell Terrier
Japanese Chin
Kelpie
Labrador Mix
Labrador Retriever
Lacy
Lhasa Apso
Lionhead
Llewellin Setter
Maine Coon
Maltese
Manchester Terrier
Manx
Martin
Mastiff
Mastiff mix
Micro Bully
Miniature Aussie
Miniature Horse
Miniature Pinscher
Miniature Poodle
Miniature Schnauzer
Mix
Mockingbird
mole
Mountain Cur
Mountain Feist
mouse
Newfoundland
Norwegian Forest Cat
Opossum
Otterhound
Owl
Papillon
Parakeet
Parrot
Peacock
Pekingese
Persian
Pig
Pit Bull Terrier
Plott Hound
Pointer
Pomeranian
Poodle
Pot belly pig
Pug
Quarterhorse
Rabbit
Raccoon
Ragdoll
rat
Rat Terrier
Redbone Coonhound
Retriever
Rex
Rex
Rhodesian Ridgeback
Rott mix
Rottweiler
Russian Blue
Saint Bernard St. Bernard
Samoyed
Schipperke
Schnauzer
Scottish fold
Scottish Terrier Scottie
Setter
Shar Pei
Shepherd
Shetland Sheepdog Sheltie
Shiba Inu
Shih Tzu
Siamese
Siberian
Siberian Husky
Silky Terrier
Silver
Silver Fox
Silver Marten
Singapura
Skunk
Skunk
Skye Terrier
Sloughi
Smooth Fox Terrier
Snake
Snowshoe
Softbill (Other)
Somali
South Russian Ovcharka
Spaniel
Sphynx (hairless cat)
Spitz
Squirrel
Staffordshire Bull Terrier
Standardbred
Sugar Glider
Swan
Swedish Vallhund
Tabby
Tan
Tennessee Walker
Terrier
Texas Heeler
Thai Ridgeback
Thoroughbred
Tibetan Mastiff
Tibetan Spaniel
Tibetan Terrier
Tiger
Tonkinese
Tosa Inu
Toucan
Toy Fox Terrier
Treeing Tennessee Brindle
Treeing Walker Coonhound
Turkey
Turkish Angora
Turkish Van
Turtle
Turtle
Unknown
Unknown
Unknown
Vietnamese Pot Bellied
Vizsla
Vulture Black
Vulture Turkey
Warmblood
waterfowl
Waterfowl
Weimaraner
Welsh Corgi
Welsh Springer Spaniel
Welsh Terrier
West Highland White Terrier Westie
Wheaten Terrier
Whippet
White German Shepherd
white-tailed deer
Wire-haired Pointing Griffon
Wirehaired Terrier
Wolf Hybrid
Wolf Hybrid
Woodpecker
Xoloitzcuintle/Mexican Hairless
Yellow Labrador Retriever
Yorkshire Terrier Yorkie
I agree to have this animal sterilized no later than (HSC 828.004):
No Yes
Date: *
Animal Name:
Ainsley (Cat - 2452254)
Arthur (Cat - 2452224)
Arvo (Dog - 2452315)
Bardo (Dog - 2452312)
Bell Pepper (Cat - 2452371)
Bellatrix (Cat - 2137068)
Belle (Cat - 2451985)
Bob (Dog - 2452320)
Bondi (Dog - 2452316)
Bryce (Cat - 2451622)
Buffy (Dog - 2451917)
Bug (Cat - 2452274)
Burkley (Cat - 2452096)
Carrot (Dog - 2452369)
Celery (Dog - 2452128)
Charmander (Cat - 2452306)
Chikorita (Cat - 2452307)
Chili (Cat - 2452063)
Chunkers (Dog - 2451906)
Clove (Dog - 2452122)
Comet (Cat - 2452310)
Cool Ranch (Cat - 2452066)
Copito (Dog - 2452351)
Crow (Cat - 2452217)
Cucumber (Dog - 2452370)
Cujo (Dog - 2452222)
Dell (Cat - 2452135)
DiDi (Dog - 2451905)
Dorothy (Cat - 2452106)
Duck (Cat - 2451981)
Duke (Dog - 2452374)
Eeyore (Dog - 2451942)
Eleanor (Cat - 2452273)
Elizabeth 4 (Cat - 2452210)
Elizabeth 5 (Cat - 2452211)
Elizabeth 6 (Cat - 2452212)
Erly (Dog - 2452144)
Fiamma (Cat - 2345410)
Free Range (Dog - 2452119)
Furrnin (Cat - 2452179)
Galloway (Dog - 2451908)
Goose (Cat - 2451979)
Gracie (Dog - 2451571)
Hodge (Dog - 2452036)
Isla (Dog - 2452317)
Jinks (Dog - 2452029)
Joe Bob (Cat - 2345220)
Joey (Dog - 2452313)
Kiyo (Cat - 2451988)
Land-in (Dog - 2452134)
Larry (Cat - 2452071)
Lemondrop (Dog - 2452267)
Lily (Dog - 2452321)
Macey (Dog - 2452338)
Maroney (Dog - 2452099)
Mary (Cat - 2451926)
Midnight (Cat - 2452105)
Minnie (Cat - 2452353)
Misky (Cat - 2452032)
Modok Alfredo (Dog - 2452305)
Musketeer (Dog - 2452270)
Ninja (Cat - 2452030)
Onion (Cat - 2452373)
Pawtricia (Dog - 2451937)
Penny (Dog - 2452350)
Pepper (Cat - 2452062)
Pluto (Cat - 2449268)
Pro Star (Dog - 2452349)
Pumpkin Spice (Dog - 2452123)
Queen (Dog - 2452065)
Radish (Cat - 2452372)
Raven (Cat - 2452216)
Roo (Dog - 2452314)
Rubble (Dog - 2451322)
Sasha (Cat - 2452272)
Sienna (Dog - 2452318)
Skittle (Dog - 2452268)
Spider (Cat - 2452276)
Spot (Dog - 2452052)
Swan (Cat - 2451978)
Taffy (Dog - 2452266)
Ten Piece (Dog - 2451907)
Test Blah (Dog - 2452271)
Tony (Cat - 2452352)
Totino (Cat - 2451761)
Werther (Dog - 2452265)
Whopper (Dog - 2452264)
Zhru (Dog - 2352306)
butterfinger (Cat - 2452295)
crunch (Cat - 2452296)
kit kat (Cat - 2452294)
Color:
Agouti
Black
Black and Brindle
Black and Brown
Black and Grey
Black and Tan
Black and White
Black brown and orange
Black, Brown, and White
Black, Brown, Merle
Black/Orange/White
Black, Tan, White
Black/White/Gray
Black/white/Orange
Black, White, & Tan
Blonde
Blue
Blue and Tan
Blue and White
Blue Brindle
Blue Merle
Brindle
Brindle and Black
Brindle and Brown
Brindle and White
Brindle/Black/White
Brown
Brown and Black
Brown and Tan
Brown and White
Brown Black and white
Brown, Green, & Blue
Brown & Grey
Brown Tan and White
Brown White and Black
Calico
Champagne
Champagne & White
Chocolate
Chocolate and Tan
Chocolate and White
Chocolate Merle
Cinnamon
Cream
Cream and Black
Cream and Brown
Cream and White
Cream, Brown, White
Dapple
Fawn
Flame Point
Ginger
Ginger and White
Golden
Gray and Brown
Green
Grey
Grey and Black
Grey and Black and White
Grey and White
Grey, Black & Brown
Grey/Black/Orange
Grey, Brindle
Grey, Brindle, White
Harlequin
Light Brown
Lilac
Lilac & Tan
Lilac Tortie
Liver
Liver and White
Lynx Point
Merle
Merle and White
Orange
Orange and Grey
Orange and White
Orange/Black/White
Orange/White/Black
Red
Red Agouti
Red and black
red and brown
Red and White
Red, Black, White
Red, White & Blue
Sable
Sable and White
Seal Brown
Silver
Silver Agouti
Sorrel
Tabby
Tabby and White
Tabby / Calico
Tan
Tan and Black
Tan and Brown
Tan and Silver
Tan and White
Tan White and black
Tortie
Tortie and White
Tricolour
Unknown
Unknown
Various
White
White and Black
White and Blue
White and Brindle
White and Brown
White and Cream
White and Grey
White and Liver
White and Merle
White and Orange
White and Red
White and Tabby
White and Tan
White and Torti
White Black and Brown
White Black and Tan
white black merle
White/Black/Orange
white/brown/black
white brown black merle
White, brown, & tan
White/Orange/Black
White, Red, Black
Yellow
Yellow and Grey
Yellow and White
Breed:
Afghan Hound
Airedale Terrier
Akbash
Akita
Alaskan Malamute
American Bulldog
American Crested
American Eskimo dog
American Guinea Pig
Anatolian Shepherd
Armadillo
Australian cattle dog/Blue Heeler
Australian cattle dog/red heeler
Australian Kelpie
Australian Shepherd
Basenji
Basset Hound
Bat
Beagle
Bearded Collie
Beauceron
Belgian Malinois
Bengal
Bernese Mountain Dog
Bichon Frise
Black and Tan Coonhound
Black Labrador Retriever
Black Mouth Cur
Bloodhound
Blue-jay
Blue Lacy
Bluetick Coonhound
Boa
Bobcat
Bombay
Border Collie
Border Terrier
Boston Terrier
Boxer
Boykin Spaniel
British Shorthair
Brittany Spaniel
Bulldog
Bullmastiff
Bull Terrier
Cairn Terrier
Calico
Cane Corso
Cardinal
Carolina Dog
Catahoula Leopard Dog
Cavalier King Charles Spaniel
Chesapeake Bay Retriever
Chicken
Chihuahua
Chinese Crested Dog
Chiweenie
Chocolate Labrador Retriever
Chow Chow
Cockapoo
Cocker Spaniel
Collie
Coonhound
Corgi
Coyote
Crossbreed
Cur
Czech Shepherd
Dachshund
Dalmatian
Doberman Pinscher
Domestic Long Hair
Domestic Medium Hair
Domestic Short Hair
Dove
Dutch
English Bulldog
English Pointer
English Setter
Feist
Ferret
Fox
Foxhound
Fox Terrier
French Bulldog
Gecko
German Shepherd Dog
German Shorthaired Pointer
Golden Retriever
Goose
Great Dane
Great Pyrenees
Greyhound
Guinea Pig
Guinea Pig
Hamster
Havana
Havanese
Hawk
Himalayan
Hound
Hound mix
Husky
Irish Setter
Irish Wolfhound
Jack Russell Terrier
Japanese Chin
Kelpie
Labrador Mix
Labrador Retriever
Lacy
Lhasa Apso
Lionhead
Llewellin Setter
Maine Coon
Maltese
Manchester Terrier
Manx
Martin
Mastiff
Mastiff mix
Micro Bully
Miniature Aussie
Miniature Horse
Miniature Pinscher
Miniature Poodle
Miniature Schnauzer
Mix
Mockingbird
mole
Mountain Cur
Mountain Feist
mouse
Newfoundland
Norwegian Forest Cat
Opossum
Otterhound
Owl
Papillon
Parakeet
Parrot
Peacock
Pekingese
Persian
Pig
Pit Bull Terrier
Plott Hound
Pointer
Pomeranian
Poodle
Pot belly pig
Pug
Quarterhorse
Rabbit
Raccoon
Ragdoll
rat
Rat Terrier
Redbone Coonhound
Retriever
Rex
Rex
Rhodesian Ridgeback
Rott mix
Rottweiler
Russian Blue
Saint Bernard St. Bernard
Samoyed
Schipperke
Schnauzer
Scottish fold
Scottish Terrier Scottie
Setter
Shar Pei
Shepherd
Shetland Sheepdog Sheltie
Shiba Inu
Shih Tzu
Siamese
Siberian
Siberian Husky
Silky Terrier
Silver
Silver Fox
Silver Marten
Singapura
Skunk
Skunk
Skye Terrier
Sloughi
Smooth Fox Terrier
Snake
Snowshoe
Softbill (Other)
Somali
South Russian Ovcharka
Spaniel
Sphynx (hairless cat)
Spitz
Squirrel
Staffordshire Bull Terrier
Standardbred
Sugar Glider
Swan
Swedish Vallhund
Tabby
Tan
Tennessee Walker
Terrier
Texas Heeler
Thai Ridgeback
Thoroughbred
Tibetan Mastiff
Tibetan Spaniel
Tibetan Terrier
Tiger
Tonkinese
Tosa Inu
Toucan
Toy Fox Terrier
Treeing Tennessee Brindle
Treeing Walker Coonhound
Turkey
Turkish Angora
Turkish Van
Turtle
Turtle
Unknown
Unknown
Unknown
Vietnamese Pot Bellied
Vizsla
Vulture Black
Vulture Turkey
Warmblood
waterfowl
Waterfowl
Weimaraner
Welsh Corgi
Welsh Springer Spaniel
Welsh Terrier
West Highland White Terrier Westie
Wheaten Terrier
Whippet
White German Shepherd
white-tailed deer
Wire-haired Pointing Griffon
Wirehaired Terrier
Wolf Hybrid
Wolf Hybrid
Woodpecker
Xoloitzcuintle/Mexican Hairless
Yellow Labrador Retriever
Yorkshire Terrier Yorkie
Breed:
Afghan Hound
Airedale Terrier
Akbash
Akita
Alaskan Malamute
American Bulldog
American Crested
American Eskimo dog
American Guinea Pig
Anatolian Shepherd
Armadillo
Australian cattle dog/Blue Heeler
Australian cattle dog/red heeler
Australian Kelpie
Australian Shepherd
Basenji
Basset Hound
Bat
Beagle
Bearded Collie
Beauceron
Belgian Malinois
Bengal
Bernese Mountain Dog
Bichon Frise
Black and Tan Coonhound
Black Labrador Retriever
Black Mouth Cur
Bloodhound
Blue-jay
Blue Lacy
Bluetick Coonhound
Boa
Bobcat
Bombay
Border Collie
Border Terrier
Boston Terrier
Boxer
Boykin Spaniel
British Shorthair
Brittany Spaniel
Bulldog
Bullmastiff
Bull Terrier
Cairn Terrier
Calico
Cane Corso
Cardinal
Carolina Dog
Catahoula Leopard Dog
Cavalier King Charles Spaniel
Chesapeake Bay Retriever
Chicken
Chihuahua
Chinese Crested Dog
Chiweenie
Chocolate Labrador Retriever
Chow Chow
Cockapoo
Cocker Spaniel
Collie
Coonhound
Corgi
Coyote
Crossbreed
Cur
Czech Shepherd
Dachshund
Dalmatian
Doberman Pinscher
Domestic Long Hair
Domestic Medium Hair
Domestic Short Hair
Dove
Dutch
English Bulldog
English Pointer
English Setter
Feist
Ferret
Fox
Foxhound
Fox Terrier
French Bulldog
Gecko
German Shepherd Dog
German Shorthaired Pointer
Golden Retriever
Goose
Great Dane
Great Pyrenees
Greyhound
Guinea Pig
Guinea Pig
Hamster
Havana
Havanese
Hawk
Himalayan
Hound
Hound mix
Husky
Irish Setter
Irish Wolfhound
Jack Russell Terrier
Japanese Chin
Kelpie
Labrador Mix
Labrador Retriever
Lacy
Lhasa Apso
Lionhead
Llewellin Setter
Maine Coon
Maltese
Manchester Terrier
Manx
Martin
Mastiff
Mastiff mix
Micro Bully
Miniature Aussie
Miniature Horse
Miniature Pinscher
Miniature Poodle
Miniature Schnauzer
Mix
Mockingbird
mole
Mountain Cur
Mountain Feist
mouse
Newfoundland
Norwegian Forest Cat
Opossum
Otterhound
Owl
Papillon
Parakeet
Parrot
Peacock
Pekingese
Persian
Pig
Pit Bull Terrier
Plott Hound
Pointer
Pomeranian
Poodle
Pot belly pig
Pug
Quarterhorse
Rabbit
Raccoon
Ragdoll
rat
Rat Terrier
Redbone Coonhound
Retriever
Rex
Rex
Rhodesian Ridgeback
Rott mix
Rottweiler
Russian Blue
Saint Bernard St. Bernard
Samoyed
Schipperke
Schnauzer
Scottish fold
Scottish Terrier Scottie
Setter
Shar Pei
Shepherd
Shetland Sheepdog Sheltie
Shiba Inu
Shih Tzu
Siamese
Siberian
Siberian Husky
Silky Terrier
Silver
Silver Fox
Silver Marten
Singapura
Skunk
Skunk
Skye Terrier
Sloughi
Smooth Fox Terrier
Snake
Snowshoe
Softbill (Other)
Somali
South Russian Ovcharka
Spaniel
Sphynx (hairless cat)
Spitz
Squirrel
Staffordshire Bull Terrier
Standardbred
Sugar Glider
Swan
Swedish Vallhund
Tabby
Tan
Tennessee Walker
Terrier
Texas Heeler
Thai Ridgeback
Thoroughbred
Tibetan Mastiff
Tibetan Spaniel
Tibetan Terrier
Tiger
Tonkinese
Tosa Inu
Toucan
Toy Fox Terrier
Treeing Tennessee Brindle
Treeing Walker Coonhound
Turkey
Turkish Angora
Turkish Van
Turtle
Turtle
Unknown
Unknown
Unknown
Vietnamese Pot Bellied
Vizsla
Vulture Black
Vulture Turkey
Warmblood
waterfowl
Waterfowl
Weimaraner
Welsh Corgi
Welsh Springer Spaniel
Welsh Terrier
West Highland White Terrier Westie
Wheaten Terrier
Whippet
White German Shepherd
white-tailed deer
Wire-haired Pointing Griffon
Wirehaired Terrier
Wolf Hybrid
Wolf Hybrid
Woodpecker
Xoloitzcuintle/Mexican Hairless
Yellow Labrador Retriever
Yorkshire Terrier Yorkie
I agree to have this animal sterilized no later than (HSC 828.004):
No Yes
Date: *
I understand that I am responsible for delivering a letter signed by the sterilizing veterinarian describing the animal and the date of sterilization no later than seven days after the animal is sterilized (HSC 828.005) *
No Yes
I understand that if Nacogdoches Animal Services does not receive a letter before the end of the seventh day after the agreed sterilization date that a complaint will be filed against you in the appropriate court (HSC 828.008) *
No Yes
I understand that if the animal dies, is lost or stolen before the sterilization completion date that I must provide a letter to Nacogdoches Animal services not later than the seventh day after the death or date of disappearance (HSC 828.007) *
No Yes
New owner signature: *
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Date: *
Animal Services staff:
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Date:
Driver's License
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