City of Waltham
610 Main Street
Waltham, MA 02452
ANNUAL DOG LICENSE
Date: _____________ License # ______________
Owner’s Name(s):_____________________________________________
Address: _____________________________________________________
Home Phone: _________________ Work Phone: ___________________
Dog Information
Please check one:
Male $10.00
Female $10.00
Neutered Male $6.00
Spayed Female $6.00
Dog’s Name: _________________________________
Breed: _______________________________________
Color: ________________________________________
Date of Birth: __________________________________
Rabies Expiration Date: __________________________
*All dogs must be licensed and vaccinated against rabies. Violators are subject to fines and penalties as described in M.G.L. Chapter 140.
OBEY THE LEASH LAW
NO DOG SHALL BE PERMITTED ON ANY S TREET OR PUBLIC PLACE IN WALTHAM WITHOUT EFFECTIVE RESTRAINT (General Ordinances Chapter 3, Art.II)