Agenda - 03-15-1983 - Laserfiche WebLink

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OFFICE USE 011 A Animal Species Animal Type Date Received _— Initials of Persons who checked in form ORANGE COUNTY WILD* ANIMAL REGISTRATION FORM Use Separate Form For Each Type Wild Animal Kept 1. Owner(s) Nime: A. Owner(i) Address ; (If on Rural Route, -- _ include Road Name) B. Owner(I) Home Telephone: C. Owner( ) Work Telephone: D. If Owner is a Corporation: I Name of Corporation: State incorporated in : Names and Addresses of principal officers: Name: Address: E. If owner is any other type of organization: — Name o organization — .._. Addres of organization: Names ind address of principal officers, director's, trustees, or man- aging officials or partners: Name: Addre ssl: F. What is the owner' s purpose in keeping the animal(s) : G. Describe owner' s qualifications to care for the animal(s) (Such as any training) : 2. Name, home addresses and telphone numbers of person(s) responsible for care of animals (If other than owner) : Name . Home Address ;