MyAult - Town of Ault

Before You Start

Before beginning this application, please ensure you have the following:

Digital copy of the vaccination of rabies certificate. The rabies must not expire before 2 months from today (August 28, 2022). If vaccination expires before the end of the year, a request for update will be made to the contact on file. Failure to provide this information will lead to penalties from Code Enforcement.

About You

This part of the form is for the submitter of this application, and that you the submitter certify that all of the information you provide on the associate license application is true to the best of your knowledge.

Please note, the receipt of this submittal will be emailed to the email you provide below.

Name:

Phone:

Email:

Owner Details

This part of the form is for the information on the owner or owners of the animal.

Owner Name(s):

Physical Location Details

Type in and select the address from the results returned of the primary residence of this animal. After doing so, please make any adjustments as required.

Address #:

Address Street:

Address #2:

Mailing Details

Address 1:

Address 2:

City:

State/Province:

ZIP code:

Other Contact Details

Email:

Phone #:

Animal Details

This portion of the form is only for the primary details regarding the name, location, and contact information of the business.

Primary Details

Animal Name:

Type:

Date of Birth (Approximate is Okay):

Sex: *

Dog Details

Breed(s): *

Color(s):

Cat Details

Breed(s): *

Color(s):

Microchip # (If Applicable):

Microchip Registry (If Applicable):

Date of Last of Rabies Vaccination: *

Expiration Date of Rabies Vaccination: *

Upload Proof of Rabies Vaccination: * Max size is 2MB (Limited to .pdf) - Current file size is:

Image of animal in order to aid in recognition if found (Optional):

Licensing & Permits

Staff Contact

Matt Prythero

matt@townofault.org

Phone #

(970) 834-2844

Address

201 1st Street,
P.O. Box 1098
Ault, Colorado 80610