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2. 
3. Return
   Go back to ACC Home
5. Pet Owner Information
7. Change of Address?

   1. Yes
   2. No
9. First Name*
10. Last Name*
12. Previous Address
13. Previous Apt #
15. Previous City
16. Previous State
17. Previous Zip
19. Current Address*
20. Apt #
22. Current City*
23. Current State
24. Current Zip*
26. Email*
27. Phone*
29. Pet Information
31. Dog Name*
32. Breed
34. License Number*
    Printed at the top, right of your dog's license/receipt
35. Status Update

    1. I am no longer the dog's owner
    2. Dog is deceased
37. By submitting this form, I swear or affirm that I am the owner or legal representative of the pet mentioned in this form.
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39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field