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Intact Cat Application

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City of Los Angeles APPLICATION FOR INTACT CAT
This Intact Cat Application shall not be accepted unless accompanied by the fee, microchip number for the applicable intact cat, as applicable, either proof of exemption to the spay/neuter requirements of Section 53.15.2 of the Los Angeles Municipal Code (LAMC) or a valid Breeder’s Permit or Breeder’s Permit Application. Fees charged are non-refundable. This permission may not be transferred. APPLICANT FIRST NAME: E-MAIL ADDRESS: MAIN TELEPHONE NUMBER: SECOND TELEPHONE NUMBER: ADDRESS*:
Number Direction Street Type

LAST NAME:

TYPE CELL TYPE CELL

Additional Address Line

City

State

Zipcode

*You must give a physical address. If desired, you may list a P.O. Box address for mailing only.

P.O. Box

City

State

Zipcode

PHYSICAL LOCATION (ADDRESS) OF CAT, if different from applicant address. SAME

Number

Direction

Street

Type

City

State

Zipcode Intact Cat - Page 1 of 4 Form 108E Rev Jun 08

NAME AND ADDRESS OF ALL OWNER(S) OF THE CAT, if in addition to or different from above. SOLE OWNER SAME AS ABOVE

PROVIDE THE FOLLOWING INFORMATION REGARDING THE CAT. Name Microchip ID No. Breed Primary color Age ________________ If mixed, prominent breed(s) Secondary color _________________ ___________________ No Male Female

Has the applicable cat had a litter(s) within the last year? Yes How many kittens? Do you plan to breed the cat during this year? Yes No

If yes, you must also obtain a Breeder’s Permit from Los Angeles Animal Services, using a separate application.

Applicant’s cat meets one of the following approved exemptions to the spay/neuter requirements of Section 53.15.2 of the Los Angeles Municipal Code (check one and attach required documentation): The cat is a breed approved by and the cat is registered with a registry or association recognized by the Department through its Commission, whose program and practices are consistent with the humane treatment of animals, and the cat is actively used to show or complete and has competed in at least one legitimate show or sporting competition hosted by, or under the approval of the recognized registry or association within the last two years, or is being trained or groomed to show or compete and is too young to have yet competed. (Attach original letter or certificate from the recognized Registry or Association. List of recognized Registries and Associations is available from Los Angeles Animal Services.) The cat has earned, or if under three years old, is actively being trained and in the process of earning, an agility or other title from a registry or association recognized by the Department
Intact Cat - Page 2 of 4 Form 108E Rev Jun 08

through its Commission. (Attach original letter or certificate from recognized Registry or Association. List of recognized Registries and Associations is available from Los Angeles Animal Services.) Due to age, poor health, or illness it is a risk to the animal’s health to spay or neuter the cat. (Attach an original letter or certification signed by a veterinarian licensed in California which shall include the veterinarian’s license number and state the specific reason for the exemption.) The cat’s health would be best served by spaying or neutering after a specified date. (Attach an original letter or certification signed by a veterinarian licensed in California which shall include the veterinarian’s license number and a statement of the specific date after which the cat may be safely spayed or neutered. Letters or certificates indicating an extension to the period shall be submitted no later than seven days prior to the specified date if deemed warranted by the veterinarian.) The cat has a valid and current Breeder’s License. (Attach a copy of the Application for Breeder’s Permit or provide your current Breeder’s Permit number for this animal.) Permit No. _____ I hereby acknowledge that I am familiar with Los Angeles Municipal Code Section 53.15.2 and I declare that (check each and initial): I understand that if the applicable cat is going to be bred during the permit period I must be in possession of a valid Breeder’s Permit, and that if I am not, I am subject to a fine, revocation of permission for an intact cat, or other penalties. Initials If the applicable cat receiving permission to remain intact unintentionally breeds during the permit period, I shall be responsible for acquiring a Breeder’s Permit and shall also be responsible for any applicable penalties. Initials The applicable cat shall be strictly confined while in heat or season in a building or other adequate enclosure designed to keep him or her on the premises of the owner, as required by the City’s Municipal Code. Initials I understand that if the applicable cat no longer meets the exemption listed above, it must be spayed or neutered within 60 days of the day the cat no longer qualifies. Initials It is my sole responsibility to promptly update any changes in the information provided on this application, including any change of addresses or telephone contact information, and fully understand that an approved intact cat permission is not transferable. Initials

Intact Cat - Page 3 of 4 Form 108E Rev Jun 08

I understand that providing false or misleading information on this application may result in an immediate denial or revocation of the intact cat license without refund of fee and an order compelling the cat to be spayed/neutered within 60 days.
Signature of Applicant Date (MM/DD/YYYY)

Intact Cat - Page 4 of 4 Form 108E Rev Jun 08


				
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