Required fields are marked with asterisks (*)

Dog Tag Cancellation Form

This form is to be completed if your dog is deceased or has been relocated.

If you have any questions or concerns please contact 519-395-3735 or hfalconer@huronkinloss.com.

First Name (Owner)

Last Name (Owner)

Phone Number

Email Address

Mailing Address

City/Town

Postal Code

Is your civic address the same as your mailing address?

Yes

Reason for cancellation

Dog is deceased

Dog relocated (to another municipality)

Dog relocated within Huron-Kinloss

Dog name

Dog breed

Other descriptive features of the dog

Date

Signature

Clear

Privacy of Information

The information supplied is for use by the Township of Huron-Kinloss and will not be sold or distributed without consent. The personal information collected will be used by the Township of Huron-Kinloss to administer Dog Tag Licensing. The collection and disclosure of the information is governed by Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), 1990. For more information or questions about the collection of information, contact 519-395-3735.

FOR OFFICE USE ONLY

Old dog tag number

Account number

Other notes