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4/11/23, 8:12AM Revize Online Forms RESIDENTIAL KENNEL ONLY: Name of Dog Breed Nikko Nova Scotia Duck Tolling Retriever Name of Dog Breed Sole Nova Scotia Duck Tolling Retriever Name of Dog Breed Presto Nova Scotia Duck Tolling Retriever Name of Dog Breed Description Description MV License # Rabies Expiration Red, white feet applied 02/14/2026 Format: MM/DD/YYYY Description MV License # Rabies Expiration Red, white feet applied 11/24/2023 Format: MM/DD/YYYY Description MV License # Rabies Expiration Red, white blax applied 06/01/2024 Format: MM/DD/YYYY MV License # Rabies Expiration M M/D D/YYYY Format: MM/DD/YYYY Upload Proof of Current Rabies Vaccinations (if records on file with the City are expired) FC hoose File] No file chosen ALL APPLICANTS: * Have you ever had a license revoked? If yes, please explain. No Will an outside kennel or fence be constructed to house the dogs? If yes, a zoning permit is required. No. Dogs live inside the home full time. Yard is fully privacy fenced for outside exercise. I compete in agility locally and nationally, which is why I have three dogs. Zoning Permit Application CLICK HERE TENNESSEN WARNING/PRIVACY POLICY The data on this form will be used to approve your license. Some requested data is private. Private data is available to you and the City or State staff who need this information to perform their duties, but is not available to the public. You are being asked to answer questions and provide information pursuant to the application process that is required by Minnesota State Statute and the City of Mounds View. The information you provide is government data in accordance with Chapter 13 of State law known as the "Minnesota Government Data Practices Act". You are not required by law or ordinance to answer questions or provide the information requested. A refusal to answer questions or provide information being requested will prevent the City of Mounds View from processing the application for which you are applying. The information you provide may be classified as "public", "private" or "confidential" pursuant to the "Government Data Practices Act". Access to this information can be obtained by persons who are deemed eligible pursuant to the "act". This access can include the subject(s) of the license application, anyone they give their informed consent to consistent with Minnesota State law, or by court order. My signature constitutes agreement of the Tennessen Warning and application. Applicant Signature Christina Wessel Date 04/10/2023 Format: MM/DD/YYYY TO PAY CLICK HERE - If you choose not to pay at this time and payment is not received within ten days of submittal, your application will become void. https://moundsviewmn.rja.revize.com/reports/318874 2/3