Application for Free Spay-Neuter

You are eligible for FREE services if you are: A) Single, not claimed as a dependent of another, and your annual income is less than $30,000 OR B) Are single with dependents, or married, and your total household income is less than $50,000. Our finances are limited so your honesty will keep the program available for those who truly need it. If you do NOT qualify, do NOT fill out this form. Go here for info about about Reduced Cost

Your First Name * Last Name * Address * City * State * Select an option:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDist of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP * Phone Number * Email * Best Time To Reach You * Pet's Name *

Type of Pet *

Cat Dog Other

Male or Female? *

Male Female Not Sure

Pet's Age * Approximate Weight (for Dogs Only) Has Your Pet Been Vaccinated For Rabies? If Yes, When? * Has Your Pet Been Vaccinated For Distemper? If Yes, When? * Does Your Pet Have Any Health Problems? * Name of Your Regular Vet, If You Have One

Please Provide a Copy of One Proof of Income (Select the Proof of Income)

Last Year's Income Tax Form Social Security Disability All W-2 forms for Your Family Section 8 Free Lunch Food Stamps VA Disability County Social Services Benefits AFDC WIC

Attach Your Proof of Income Document. Contact us if you need help attaching your proof of income and please continue to complete the form.

 

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Date: Saturday, 27 July 2024 (EDT)

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