APPENDIX B: CONTROLLED ANIMAL PERMIT FORM

 

TOWN OF BREMEN, INDIANA CONTROLLED ANIMAL PERMIT        Permit No. __________   Applicant’s Name: __________________________________________________   Address: __________________________________________ Phone: ______________________   Type of Controlled/Exotic Animal ____________________________________________________   Number of Animals __________        Fee $100.00 per animal: ____________________     If Applicable:   Federal Permit Number ____________________   State Permit Number ______________________     Applicant Signature ______________________________ Date ____________________     ______________________________ Approved by: Clerk-Treasurer

 

(Prior Code, Ch. 71)