Town of Riga
DOG IDENTIFICATION #
Dogs Name
Microchip No.
DOG LICENSE
Dog Breed
Dog Color(s)
LICENSE TYPE
Dog’s Yr. of Birth Last 2 Digits
ORIGINAL
TRANSFER OF OWNERSHIP
Markings
OWNER IDENTIFICATION
Last
First
Middle Initial
Mailing Address: House No. Street or R.D. No. and P.O. Box No.
State
TYPE OF LICENSE
1.  Male, neutered/Female, spayed
2.  Male, unneutered/Female, unspayed
OWNER’S PHONE NO.
Area Code
Phone No.
City
County
RENEWAL
Zip
Town, City or Village
Fee
9.00
17.00
Please make your check payable to the Town of Riga.
Please also send a copy of the rabies certificate and neutered/spay certificate if applicable.
All dogs 4 mos. & older must be licensed in the Town that they reside.
Office Use Only- Rabies Info:
Vet: ________________________
Manufacturer: ________________
Serial Number: _______________
Date Vacc: ________________ 1 or 3 year
_________________________________________________________________________________
Owner’s Signature
Date
________________________________________________
Clerk’s Signature
Date
Please mail or drop off at the Town Hall, PO Box 377 (6460 Buffalo Road), Churchville NY 14428
OWNER’S INSTRUCTIONS
1.
2.
3.
4.
5.
All dogs 4 months of age or older are to be licensed. In addition, any dog under 4 months of age, if running at large must be licensed.
Print all information in the appropriate boxes and sign the form.
Markings - please indicate if one or both ears have been cut off wholly or in part.
Choose from the list below one breed and one or two colors that best describes your dog and enter name on the license application.
For validation of this license submit in person or by mail, this application, fee, certification of spaying or neutering or proof of
exemption, and proof of exemption, and proof of rabies vaccination where required to the issuing clerk in the town, city or village where
the dog is harbored.
MIXES
BREED
BREED
BREED
Collie Mix
Hound Mix
Long Hair Mix
Setter Mix
Shepherd Mix
Smooth Hair Mix
Spaniel Mix
Terrier Mix
Toy Mix
Labrador Mix
Other Mix Breed
Bullmastiff
Bull Terrier
Cairn Terrier
Chesapeake Bay Retriever
Chihuahua
Chow Chow
Cocker Spaniel
Collie
Dachshund
Dalmatian
Doberman Pinscher
English Cocker Spaniel
English Setter
English Springer Spaniel
Fox Terrier
German Shepherd
German Shorthaired Pointer
German Wirehaired Pointer
Golden Retriever
Gordon Setter
Great Dane
Great Pyrenees
Irish Setter
Irish Wolfhound
Italian Greyhound
Japanese Chin
Keeshond
Kerry Blue Terrier
Labrador Retriever
Lhasa Apso
Maltese
Manchester Terrier
Mastiff
Miniature Pinscher
Miniature Schnauzer
Newfoundland
Norwegian Elkhound
Old English Sheepdog
Papillon
Pekinese
Pomeranian
Poodle
Pug
Rhodesian Ridgeback
Rottweiler
St. Bernard
Saluki
Samoyed
Schipperke
Scottish Terrier
Shetland Sheepdog
Shih Tzu
Siberian Husky
Silky Terrier
Soft Coated Wheaten Terrier
Standard Schnauzer
Vizsla
Weimaraner
Welsh Corgi (Pembroke)
Welsh Terrier
West Highland White Terrier
Whippet
Yorkshire Terrier
Foxhound
Coonhound
Terrier
Spaniel
Husky
Hound
Sheepdog
Other Purebred
BREEDS
Afghan Hound
Airedale Terrier
Akita
Alaskan Malamute
Am. Staffordshire Terrier
Australian Terrier
Basenji
Basset Hound
Beagle
Bichon Frise
Bloodhound
Borzois
Boston Terrier
Bouviers Des Flandres
Boxer
Brittany Spaniel
Bulldog
COLORS
Black
Brindle
Brown (Liver)
Gold
Grey (Bluemerle)
Red
Spotted (Patched)
Tan (Beige)
White
Apricot
Blonde
Salt and Pepper
Silver
Ticked
Yellow
Rust
Sable
Orange
Tri-Color