Brevard County Animal Services 1515 Sarno Rd., Bldg. A Melbourne, FL 32935 (321)255-4346

Spay/Neuter
Rebate Application

Please type or print

NAME OF APPLICANT (Animal Owner) _____________________________________

CURRENT MAILING ADDRESS ___________________________________________

CURRENT STREET ADDRESS ____________________________________________

CITY __________________    ZIP ________    TELEPHONE ____________________

TYPE OF ANIMAL     DOG        CAT

                                     MALE      FEMALE

NAME _________________  COLOR ______________ BREED ____________________

RABIES CERTIFICATE NO. _________________________________________________

BREVARD COUNTY ANIMAL LICENSE TAG NO. ______________________________

COPIES ENCLOSED:    *Florida State Drivers License or ID
                                        *Proof of Rabies Vaccination
                                        *Proof of Brevard County Animal License Tag
                                        *Proof of Sterilization

DATE ____________  SIGNATURE OF APPLICANT ______________________________

DATE ____________  SIGNATURE OF AS OFFICIAL _____________________________