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PET DEATH CERTIFICATE
Pet InformatIon
License No.
Canine ❍
Feline ❍
Pet’s Name Gender Breed Date of Death
Owner’s Last Name/First Name Email Address (if applicable) Phone No.
Address City Zip Code
VeterInary ClInIC InformatIon
Clinic Name Address Station No.
Veterinarian (Print Name) DVM License No. Phone No.
Signature Date
• DeathCerticateisnottobemailedorfaxed.PleaseremitalongwiththeMonthlyAccountingReportandvaccinerecords.
• Toviewthestatus/informationofanypetaccount,pleaselogontoourwebsitewww.miamidade.gov/animals/andclickon
‘Licenses’iconfollowedby“DogLicenseLook-up.”Enterthemostrecentdoglicensenumber.
• Foradditionalinformation,pleasecall3-1-1.
119_01-110 8/12
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