Official Hearing/Guide Service Detection Dog Tag Order
For Department Used Only
DL-123 (rev 12/03)
Date Ree'd.
NEW YORK STATE
Department of Agriculture & Markets
Dog Licensing Unit
Albany, NY 12235
Tag No. issued
Date Mailed
Remarks
OFFICIAL HEARING/GUIDE, SERVICE, DETECTION DOG TAG ORDER
FREE OF CHARGE
DO NOT MAIL TO NAPANOCH
MAIL COMPLETED FORM DIRECTLY TO AGRICULTURE & MARKETS
Date
Dog License 10 No.
Expiration Date
Dog Breed
Color
Dog is a graduate ofwhat training school:
Owner's Name
ALL INFORMATION MUST BE COMPLETED
BEFORE TAG CAN BE ISSUED.
,.,ddress
Telephone (
(Owner's Signature)
TO BE COMPLETED BY TOWN/CITYNILLAGE CLERK:
County
Code DO
TCV DO
T/CN
I hereby affirm under penalty of perjury that the information provided on this form is true to the best of my
knowledge and belief. False statements made herein are punishable pursuant to section 210.45 of the penal
law.
(Clerk's Signature)
'lFFICIAL TAG WILL BE MAILED DIRECTLY TO OWNER WITHIN 15 DAYS. MAIL ORIGINAL TO DEPARTMENT OF
,GRICUL TURE & MARKETS. COpy RETAINED BY OWNER.