TOWNSHIP OF DENNIS P.O. BOX 204, 571 PETERSBURG ROAD DENNISVILLE, NEW JERSEY 08214 2008 CAT SPAYING/NEUTERING FORM

DATE: _____/______/_______

AUTHORIZATION NO: _____________________

This cat spaying/neutering program has a cap on funds. The program will be administered on a first come first serve basis. There will be a limit of two (2) cats per household. The first 40 applicants will be issued an authorization number.

NAME OF APPLICANT:___________________________________________________ ADDRESS: _____________________________________________________________ TOWN:_______________________________________STATE:_______ZIP_________ PROOF OF RESIDENCY:_____________________________________________________________ BLOCK & LOT #:_________________________________________________________ NAME OF CAT:________________________________________    MALE    OR    FEMALE    (Please circle one)

The costs associated with the program are as follows: Total Cost: Female Cat = $45.00        Male Cat = $30.00 Cost to Township: Female Cat = $22.50        Male Cat = $15.00 Cost to Owner: Female Cat = $22.50        Male Cat = $15.00

The service includes the following: Neutering or Spaying, a Distemper shot and a Rabies shot. This service is being provided in cooperation with the Cape May County Animal Shelter Alliance (CMCASA), 110 Shelter Road, Cap May Court House, New Jersey. For more information or to schedule your appointment please call the clinic at (609) 465-6388.

OWNERS SIGNATURE:________________________________________________________ TOWNSHIP APPROVAL:_______________________________________________________