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TOWN OF BURKE 5365 Racer Road Madison, WI 53718 Phone: 6088258420 FAX: 6088258422 2014 DOG LICENSING APPLICATION Dog Owners Name: Address: Number/Street City Zip Neutered Male/Spayed Female $20.00
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2014 31st 1st Reiner Unspayed Unneutered Spayed LICENSING Dec annually certify WI Neutered VACCINATION payable renewal expiration Expires Treasurer veterinarian stamped vaccine

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