APPENDIX B: SHELTER RELEASE FORM

DATE:                 

I have this day released from the City of Aitkin shelter a canine of the following description:

 

Canine Description   Sex:                     Color:                            Breed:                                   Approximate Age:                                                                          Name of Owner (if known):                                                                                   Address of Owner (if known):                                                                               Location of Seizure:

 

To the following party:

 

Name:                                                                                                    Address:                                                                                                 Phone #:                                                                                                 Impound Fee Paid: $ Pickup Fee Paid: $   Veterinarian Fee Paid (if any): $   Licensed:

 

Signature of Owner or Representative:                                                                                    

Officer Badge #