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2. First Name
3. Last Name
5. Primary Phone
6. Secondary Phone
8. Email Address
9. Person ID
   (On the top, right of receipt or bottom left of license renewal notice)
13. Previous Address
15. City
16. State
17. Zip
21. New Address
23. City
24. State
25. Zip
27. Resident

    1. No Longer Resident

    Check only if you are no longer a resident of the City of Rogers.
31. Pet Name
32. Breed
33. License Number
35. Color
36. Age
37. Microchip Number
39. Sex

    1. Neutered
    2. Spayed
    3. Unaltered Male
    4. Unaltered Female
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41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field