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4/19/23, 10:39 AM <br />Revize Online Forms <br />Dog Kennel License Application <br />Submitted by: Christina Wessel <br />Submitted On: 2023-04-19 10:38:51 <br />Submission IP: (97.127.112.44) <br />proxy-IP (raw-IP) <br />Status: Open <br />* Applicant First Name <br />Christina <br />* Applicant Home Address <br />8373 GROVELAND CT <br />Print <br />DOG KENNEL LICENSE APPLICATION <br />2401 Mounds View Blvd. I Mounds View, MN 55112 <br />(763) 717-4000 1 Fax (763) 717-4019 <br />info@moundsviewmn.org <br />MI * Applicant Last Name <br />Wessel <br />City <br />MOUNDS VIEW <br />* Email * Phone <br />wessel75@gmail.com 6513085821 <br />vaiiu "111011 INU"Ull uu <br />Business Name (If Commercial) <br />State Zip Code <br />MN 55112 <br />Phone 2 <br />Ex. (123) 456-7890 <br />If the applicant is not the owner of the property, please complete the section below: <br />* Owner Name Address, State, Zip * Email <br />Eric Rautio 8373 GROVELAND CT yorcirel@gmail.com <br />* Phone 1 <br />6123846045 <br />Phone 2 <br />Ex. (123) 456-7890 <br />$45 Annually / Residential Kennel - 3 to 4 Dogs <br />❑ $80 Annually / Commercial Kennel - 5 or More Dogs (Tax Clearance and Workers Comp Form Required) <br />Required if applying for a commercial kennel license: <br />• Tax Clearance/MN Workers Comp Form CLICK HERE <br />• Certificate of Insurance for your business <br />Apt/Unit <br />https://moundsviewmn.rja.revize.com/reports/322647 1 /3 <br />