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Animal License Change Request

2. Client ID*
4. First Name
5. Last Name*
6. Phone Number*
8. Address*
   Line 1
10. Address
    Line 2
12. City*
13. State*
14. Zip Code*
16. Email Address
18. Pet Name*
19. Type*
    -- Select One --DogCat
20. Sex
    -- Select One --MaleFemale
22. Breed
23. Color
25. Reason for Change?
    -- Select One --Moved out of NorfolkMoved out of StatePet DeceasedAnimal was a strayPet Rehomed
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field