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Animal License Change Request
This form has been modified since it was saved. Please review all fields before submitting.
Client ID
*
First Name
Last Name
*
Phone Number
*
Address
*
Line 1
Address
Line 2
City
*
State
*
Zip Code
*
Email Address
Pet Name
*
Type
*
-- Select One --
Dog
Cat
Sex
-- Select One --
Male
Female
Breed
Color
Reason for Change?
-- Select One --
Moved out of Norfolk
Moved out of State
Pet Deceased
Animal was a stray
Pet Rehomed
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