2. Garland County Sheriff Office - 525 Ouachita Ave. Hot Springs, AR 71901
4. Date*
   Date
6. First Name*
7. Last Name*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number
16. Work Number
18. Email Address
20. Driver's License #*
21. State*
23. Proof of Residency*
    Energy provider bill. Bank statement. Tax assessment. Photographic ID. Mortgage statement. Certificate of voter registration.
25. Does animal have a current rabies immunization certificate?

    1. Yes
    2. No
26. Proof of Rabies Immunization
    Current Rabies Certificate If none, a rabies immunization will be required before a spay or neuter can be performed.
28. Species:*
    -- Select One --DogCat
29. Sex:*
    -- Select One --MaleFemale
30. Age:*
    Age of Animal
32. If Female, is the animal:

    1. In Heat
    2. Pregnant
33. If Cat, do you have access to a carrier:

    1. Yes
    2. No
35. Please bring this form to the above address. You will recieve a list of participating veterinarians and a voucher for $50.00 off the cost of a spay or neuter.
37. I swear/affirm that these answers are true and correct to the best of my knowledge
39. Signature*
40. Date:*
    Date:
Leave This Blank:


41. Print Only

* indicates a required field