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2. 
3. Exotic Animal Registration Form
5. Owner/Keeper of Animal information
7. First Name*
8. Last Name*
10. Address*
12. City*
13. State*
14. Zip*
16. Phone *
17. Email *
19. Exotic Animal Information
21. Name Of Animal *
22. Breed*
24. Identifying Characteristic *
25. Age *
27. Permit # *
29. Veterinarian *
30. Phone *
34. Emergency Contact
36. First Name*
37. Last Name*
39. Address*
41. City*
42. State*
43. Zip*
45. Phone *
46. Alt Phone*
48. IMPORTANT:

     If the location on the registration of where the animal is being kept is changed, the animal control division must be notified in writing within 14 days of the new location. M.O # 18-131

     

50. Use the space below to describe your emergency plan for a hurricane or disaster as required by M.O # 18-133 Disaster Plan.*
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field