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4/27/23, 9:14 AM <br />Revize Online Forms <br />Dog Kennel License Application <br />Submitted by: Joe Lundy <br />Submitted On: 2023-04-26 15:18:47 <br />Submission IP: (75.73.213.34) <br />proxy-IP (raw-IP) <br />Status: Open <br />MOUNDS ?1V1 E W <br />* Applicant First Name <br />Joe <br />* Applicant Home Address <br />2801 County Road H <br />City <br />Mounds View <br />* Email * Phone <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 />State <br />Lundy <br />Phone 2 <br />Zip Code <br />55112 <br />joelundy@live.com 3202910822 Ex. (123) 456-7890 <br />Valid Email Required <br />Business Name (If Commercial) <br />If the applicant is not the owner of the property, please complete the section below: <br />* Owner Name <br />Joe Lundy <br />* Phone 1 <br />3202910822 <br />Address, State, Zip <br />* Email <br />joelundy@live.com <br />Phone 2 <br />Ex. (123) 456-7890 <br />0 $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/325713 1 /3 <br />