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| A penalty shall be assessed if Dog License is not secured on or before January 31, or within 30 days after the dog becomes 3 months of age, or is brought from outside the state R.C. Sec. 955.01.05 | |
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| The undersigned says that the facts indicated above ARE TRUE. | |
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| Name: _____________________ | |
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| Address:_____________________ | |
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| City/State/Zip____________________ | |
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| Signature of Applicant ______________________ | |
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| Telephone No. ________________ Date ____________________
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