"Animal Rescue Registration" - Ohio

Animal Rescue Registration is a legal document that was released by the Ohio Department of Agriculture - a government authority operating within Ohio.

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ANIMAL RESCUE REGISTRATION
NEW REGISTRANT
RENEWAL
YOUR REGISTRATION NO. CB
Name of Animal Rescue to be registered:
TIN, as applicable:
Is the entity a nonprofit registered with the IRS?
Yes
No
Type of Organization:
Individual
Partnership
LLC
Corporation
Other (Specify)
Mailing Address:
City:
State:
Zip:
County:
Phone:
Cell:
Fax:
Email:
DOB of Registrant:
Date of Incorporation if Entity, State of Incorporation if Entity:
/
HOLDING FACILITY INFORMATION
Holding Facility Address:
(if different than mailing address where animal(s) will be held)
City:
State:
Zip:
County:
NAME AND ADDRESS OF INDIVIDUALS PROVIDING FOSTER HOMES TO ANIMAL RESCUE
*Please use additional sheets if needed.
:
First Name:
MI
Last Name
Address (Street Number, Street, City, State and Zip Code)
Last Name:
First Name:
MI
Address (Street Number, Street, City, State and Zip Code)
Last Name:
First Name:
MI
Address (Street Number, Street, City, State and Zip Code)
Has any registrant on this application ever been convicted of a felony, or any crime related to cruelty to animals,
or prohibitions concerning companion animals?
Yes
No
Veterinarian: ________________________
Alternate Veterinarian: ________________________
Phone No: __________________________
Phone No: __________________________________
The foregoing statements concerning the registration of an animal rescue located in Ohio are, to the best of my knowledge and
belief, true and correct, I (we) agree to keep records of annual registration for a period of twelve months showing proof of
compliance with section 956.06 of the Ohio Revised Code, including the name and address of each person from whom I (we)
utilize as a foster home. I (we) agree to permit the Ohio Department of Agriculture, or any of its authorized agents, to inspect
my (our) records at any time. Failing to renew a dog rescue registration prior to its expiration date shall result in a
late renewal fee of two hundred dollars.
Signature of the Registrant or one authorized to sign:
Date Application Made:
Printed Name:
ANIMAL RESCUE REGISTRATION
NEW REGISTRANT
RENEWAL
YOUR REGISTRATION NO. CB
Name of Animal Rescue to be registered:
TIN, as applicable:
Is the entity a nonprofit registered with the IRS?
Yes
No
Type of Organization:
Individual
Partnership
LLC
Corporation
Other (Specify)
Mailing Address:
City:
State:
Zip:
County:
Phone:
Cell:
Fax:
Email:
DOB of Registrant:
Date of Incorporation if Entity, State of Incorporation if Entity:
/
HOLDING FACILITY INFORMATION
Holding Facility Address:
(if different than mailing address where animal(s) will be held)
City:
State:
Zip:
County:
NAME AND ADDRESS OF INDIVIDUALS PROVIDING FOSTER HOMES TO ANIMAL RESCUE
*Please use additional sheets if needed.
:
First Name:
MI
Last Name
Address (Street Number, Street, City, State and Zip Code)
Last Name:
First Name:
MI
Address (Street Number, Street, City, State and Zip Code)
Last Name:
First Name:
MI
Address (Street Number, Street, City, State and Zip Code)
Has any registrant on this application ever been convicted of a felony, or any crime related to cruelty to animals,
or prohibitions concerning companion animals?
Yes
No
Veterinarian: ________________________
Alternate Veterinarian: ________________________
Phone No: __________________________
Phone No: __________________________________
The foregoing statements concerning the registration of an animal rescue located in Ohio are, to the best of my knowledge and
belief, true and correct, I (we) agree to keep records of annual registration for a period of twelve months showing proof of
compliance with section 956.06 of the Ohio Revised Code, including the name and address of each person from whom I (we)
utilize as a foster home. I (we) agree to permit the Ohio Department of Agriculture, or any of its authorized agents, to inspect
my (our) records at any time. Failing to renew a dog rescue registration prior to its expiration date shall result in a
late renewal fee of two hundred dollars.
Signature of the Registrant or one authorized to sign:
Date Application Made:
Printed Name: