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Signature <br /> I certify that I have received, read, understood, and agree to comply with state law and rule regulating <br /> this licensing category. I also certify that the information submitted is true to the best of my knowledge <br /> and belief. I understand that the limited veterinary services are limited to electronic identification, surgical <br /> sterilization, and vaccinations. I understand that all services must be provided by a licensed veterinarian <br /> or veterinary technician acting within their scope of practice. <br /> Signature Owner/Authorized Representative Date <br /> Cassie Franklin — Mayor <br /> Print name Print title <br /> ATT STm <br /> WL Office of the City Attorney <br /> City Clerk APPROVED AS TO FORM <br /> David C. Hall, City Attorney <br /> DOH 672-069 October 2014 Page 3 of 3 <br />