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2. Return
   Go back to ACC Home
4. Pet Owner Information
6. Change of Address?

   1. Yes
   2. No
8. First Name*
9. Last Name*
11. Previous Address
12. Previous Apt #
14. Previous City
15. Previous State
16. Previous Zip
18. Current Address*
19. Apt #
21. Current City*
22. Current State
23. Current Zip*
25. Email*
26. Phone*
28. Pet Information
30. Dog Name*
31. Breed
33. License Number*
    Printed at the top, right of your dog's license/receipt
34. Status Update

    1. I am no longer the dog's owner
    2. Dog is deceased
36. By submitting this form, I swear or affirm that I am the owner or legal representative of the pet mentioned in this form.
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field