Town of Edgewood

TOWN OF EDGEWOOD

ANIMAL CONTROL

RECLAIM AGREEMENT

NAME: ______ADDRESS: ______

PHONE: ______CITY: ______STATE: ______

WK PHONE: ______DOB . ZIP: ______

DRIVERS LICENSE: .

ANIMAL INFORMATION

ANIMAL’S NAME: ______IMPOUND # ______

TYPE / BREED: ______COLOR: ______

SEX: M __ F __ SPAYED: __ NEUTERED: __ INTACT: __ APPROX. AGE: ______

RABIES # ______1yr __ / 3yr __ VETERINARIAN:______EXP. DATE______

1)STATE OF NEW MEXICO AND THE TOWN OF EDGEWOOD ANTI-RABIES VACCINATION REQUIREMENTS

The New Mexico Rabies Control Act and Town of Edgewood Animal Control Ordinance., require that every person

Keeping, harboring, or having any animals over three months of age shall cause such animal to be vaccinated with anti-rabies vaccine by a licensed veterinarian. You are hereby instructed to have the animal which you have reclaimed from theTownof Edgewood Animal Control vaccinated with anti-rabies vaccine by(Date)______.

2)STATE OF NEW MEXICO AND TOWN OF EDGEWOOD STERILIZATION DEPOSIT REQUIREMENTS:

An unsterilized animal reclaimed by its owner shall not be released without being sterilized unless a twenty-five dollar ($25.00) sterilization deposit is paid in addition to any impoundment fees imposed by Animal control. By the owner signing this agreement the Owner agrees to sterilize the animal within thirty days after release (or before the animal is six months old). The sterilization deposit shall be reimbursed when the owner gives Animal Control a receipt from a veterinarian providing that the animal has been sterilized. I hereby agree to have the animal surgically sterilized by a licensed veterinarian by: (Date)______and to pay any fees in excess of the sterility deposit directly to the veterinarian performing the surgery. The Animal control Center assumes no responsibility for fees in excess of the sterility deposit. FAILURE TO COMPLY WITH THE TERMS OF THIS AGREEMENT WILL RESULT IN LEGAL ACTIONAS SET FORTH BY LAW.Adopter agrees to pay reasonable attorney fees and court costs in the event this matter is forwarded to an attorney for enforcement.

SIGNED: ______DATE: ______

______

FOR ACC USE ONLY

First Reminder Date: ______Second Reminder Date: ______

Complaint # ______Date:______

______

P.O. BOX 3610 EDGEWOOD, NEW MEXICO 87015 Ph: 505-286-4518 Fax: 505-286-4519

Revised 1/2013

Employee releasing animal:______(initial)

FEES DUE:

Reclaim Fee: .

Town License: .

Room and Board: .

Veterinarian Fees: .

Sterilization Deposit: .

Micro-Chip Fee: .

Total: .

Statement of Ownership/Custodial Care

I herby swear or affirm, under penalty of perjury, that I am the true and lawful owner or that I am in care

and custody (Custodian) of the above described animal. I affirm that this is my animal or an animal for which

I am a Custodian. I understand that false information provided in this statement may be cause for

Prosecution.

Signature: . Date: .

Please initial one: Owner Custodial Care Person

To be completed by Notary Public only: .

Subscribed and sworn to before me this .Day of .20 .

Notary Public: .

My Commission Expires: .