2. Please fill out and submit information below, if you do not plan on making your payment through the front desk at City Hall.
4. First Name*
5. Last Name*
7. Mailing Address:
9. Street Number
10. Street Name
11. Street Direction
12. Apt #
14. Box #:
16. City*
17. Province*
18. Postal Code*
20. Reply Email Address:
22. Telephone No:*
24. Nov 1 - Jan 31 ($10 off regular priced Pet License):

    1. $20.00 - Spayed or Neutered
    2. $40.00 - Unspayed or Unneutered
25. Feb 1 - Dec 31:

    1. $30.00 - Spayed or Neutered
    2. $50.00 - Unspayed or Unneutered

27. $10.00 - Replacement Tag

28. Aug 1 - Dec 31:

    $20.00 flat rate - New Dog Only (spayed/neutered/intact)

30. Sex:

    1. Male
    2. Female
31. Has paid the following sum:
33. For the following dog:
35. Name of Dog:*
37. Breed:*
38. Colour:*
40. Expected Date of Payment:
    Expected Date of Payment:
42. Method of Payment:

    1. City Hall Drop Box
    2. Mailed Cheque
    3. Online Banking Payment (see next to complete banking information below and read instructions)
44. (Post-marks and drop box payments received after the deadline will not be accepted for discount)
46. Name of Financial Institution
47. Name of Payee on account
49. If paying through online banking, please make your payment to the following account: • Payee – “Salmon Arm (City of) Property Taxes” • Account Number – 99999999 (Do NOT make your payment to your property tax account)
51. Delivery Method

    1. Pickup at City Hall
    2. Mail
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field