CITY OF NEW AUBURN 2014 DOG LICENSE APPLICATION
Instructions: Please print all answers, include a copy of the rabies inoculation and make checks payable to the “City of
New Application Renewal Application
Owner's Name ______________________________________________________
Owner's Address ________________________
Owner's Telephone ___________________ Unlisted Phone Number
Name of Dog _____________________________
Breed of Dog _____________________________
Age of Dog __________________ Colors/Markings _____________________
Sex of Dog: Male Femal
Is the dog Spayed or Neutered? Yes No
Expiration of Rabies Inoculation ____________________________
(Please attach Rabies Shot Papers)
Spayed or Neutered Dog - $10.00
Non-Spayed or Neutered Dog - $10.00
Shipping and handling charge - $1.25
(this fee is only if you request the tags be sent to you by mail)
Ordinance #501: Any dog 6 months or older requires a license. You may keep up to three (3) dogs, cats or a combination of the two. A certificate of Rabies Vaccination is requested. The owner shall see that the tag be constantly worn by the dog.
For Office Use Only
Date Received __________________ License No. _______________ Issue Date __________
Amount Received _______________ Check No. ________________
PROPERTY OWNER INFORMATION
Mailing Address (if different)
RENTER INFORMATION (IF APPLICABLE)
Mailing Address (if different)
Address of property:
Number of Persons
Residential or Business (what kind of business)
It is hereby understood by applicant that water and sewer is billed monthly; payment must be received in City Hall prior to 5:00 pm on the last day of the month to avoid any late charges. A late charge will be added to all past due amounts.
It is also understood by the applicant that if the account becomes past due, the City of
An amount due for utility charges may be certified to the Sibley County Auditor for collection with real estate taxes in the following year in accordance with MN Statutes 444.075. This certification will be made regardless of who applied for the services; whether owner, tenant or other person, these charges are filed against the property.
No water will be turned on without the land owner’s signature.
I have read this application and agree to follow the instruction of this application and the City Ordinance.
RENTER’S SIGNATURE (IF APPLICABLE) DATE
PROPERTY OWNER’S SIGNATURE DATE
CITY EMPLOYEE’S SIGNATURE DATE
The following information is requested by the Federal government in order to monitor compliance with Federal laws prohibiting discriminating against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required not to determine race/national origin of individual applicants on the basis of visual observation or surname.
_________ Hispanic or Latino
__________ Not Hispanic or Latino
Race of Household:
___________ American Indian/Alaskan Native
___________ Black or African American
___________ Native Hawaiian or Other Pacific Islander
Number of person’s in the household:
If you feel you have been discriminated against: To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue SW, Washington, DC 20250-9410 or call (202) 720-5964.
City of New
Variance/Conditional Use Permit
Date: _______________ Phone 320-864-5831
Fee Paid: _________________ NewAuburn@embarqmail.com
Type of request: ________Variance ________Conditional Use Permit ________Land Use Permit ________Other
New ______________ Renewal ___________
Street Location of Property________________________________________
Legal Description of Property:
Owner: Name: __________________________ Phone: ____________________________
Applicant (If other than owner):
Name: ______________________________ Phone: _______________________
Description of Request:
Reason for Request:
Signature of Applicant Date
Please use the back side of the application to show lot lines, street names, distance from side and rear lot lines, setback from front lot line to structure. For garage, show distance from garage to house, garage to side or rear lot lines. If applicable, include landscaping, off-street parking, grade elevation of streets and location of access drives. Show North direction.
Office use only
Hearing Date (if applicable):______________________ Approved__________ Denied__________