DOG LICENSE APPLICATION
OWNER INFORMATION:
Name:__________________________________________________________________
Residence Address:________________________________________________________
City:________________________________________________Zip:________________
Mailing Address: _________________________________________________________
City:________________________________________________Zip:________________
Phone (Cell): _______________(Home):_______________ (Work):_________________
PET INFORMATION:
Is this a new______ or renewal_____ Loudoun County license?
If renewal, please provide previous license #:_______________ and Year:____________
Name:___________________________ Microchip #: ____________________________
Breed: _________________________DOB:________Color(s):_____________________
Rabies expiration date:_________________[Please attach Certificate – will be returned]
Sex: Female: ____ Male: _____ Spayed or neutered? No____ Yes____
Guide or Assistance Dog? No______ Yes______
Fees (per year): Male or Altered Male: $10.00
Female or Spayed Female: $10.00
Amount Enclosed: $_____________ (MAKE CHECKS PAYABLE TO "COUNTY OF LOUDOUN")
Depending on your dog’s rabies expiration date, you have the option to purchase a one,
two or three year dog license. Dog licenses expire the month and day of the dog’s rabies
expiration date.
Mail this application, rabies vaccination certificate and your check to:
Loudoun County Animal Services, 39820 Charles Town Pike, Waterford, VA 20197
Licenses can also be obtained at two treasurer's offices:
1 Harrison Street, 1st Floor or
21641 Ridgetop Circle, Suite 104
Leesburg, VA 20177
Sterling, VA 20166
703-777-0280
703-777-0280
8:30am-5:00pm Mon-Fri
8:30am-5:00pm Mon-Fri
*Please call to verify hours as they are subject to change.