Release Form - Change of Ownership
I do hereby release ownership of my dog
to_________ ____________________________________
I understand that upon giving my dog to the above named person, that person becomes the sole owner of the dog. I will make no
attempt to reclaim my dog. I fully grant this person the right to give my dog any medical treatment deemed necessary, and to
possibly place the dog in a good adoptive home. Should a veterinarian determine my dog is too ill to be treated, if necessary, I give
the above named person the right to put said dog humanely to sleep. I release the above named person from all liability concerning
said animal, and the above named person will make every attempt to provide adequate care and find a permanent home.
I HEREBY STATE THAT I AM GIVING UP MY DOG OF MY OWN FREE WILL.
Dog's Name___________ __________________________________
Breed__________Havanese__________________________ Color_________
Age_____ __________ Birthdate (if known)
______________________Sex_______ ____
Owner's info_ Jack Anderson___________________________
Name
___ ___________________________________
Address, City, State, Zip
213 770 6807
Telephone number
_____ _______________________________________________________ _______
Owner's Signature
Date
Buyer's info_ ___________________________
Name
___ __________________________________________________
Address, City, State, Zip
Telephone number
___________________________________________________________________
Owner's Signature
Date