Thank you for your interest in BEHAF. Please submit your completed application with supporting documents to: Ruth Nielsen, Nielsen Law Office Inc., P.S., 927 N. Northlake Way Suite 301, Seattle, WA 98103-1119. Once your application is received, the BEHAF Board of Directors will convene to take action on your application. You will be notified by mail as soon as a decision has been reached. All financial information will remain strictly confidential. The decision of the BEHAF Board of Directors is final.
INSTRUCTIONS: Please complete the following information, attaching additional pages as needed. Enclose a copy of your latest federal income tax return (or equivalent for applicants who are not residents of the United States) and a recent photograph of your dog. Have your veterinarian mail the medical certification directly to BEHAF at the address above.
Name : _______________________________________________________________________________________
Address:______________________________________________________________________________________
Telephone number: (day)___________________________________ (evening) ______________________________
Occupation: (husband) ____________________________________ (wife): __________________________________
Total number of people living in home - Adults:______________________ Children: ____________________________
Total number of pets/animals owned by the entire family and type: ___________________________________________
______________________________________________________________________________________________
Do you breed any animals? If yes, please
specify the species, breed, and approximate number of offspring each year:
_________________________________________________________________________________
_________________________________________________________________________________
Registered name of dog requiring assistance:____________________________________________________________
Call Name: __________________________________Registering body: ______________________________________
Name of breeder where dog was aquired: _______________________________________________________________
Address: ________________________________________________________________________________________
Telephone number: _______________________________________
Application - page 2 | Application - page 3
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