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Print Form ADLEB - VOM/TF Pennsylvania Bureau of Dog Law Enforcement PERMANENT IDENTIFICATION VERIFICATION FORM MICROCHIP TATTOO MUST BE COMPLETED BY PERSON IMPLANTING OR SCANNING MICROCHIP or DOG S NAME DOG S BREED DOG S DOB MO DAY DOG S COLOR/ MARKINGS DOG S SEX NEUTERED MALE FEMALE SPAYED YR SPOTTED WHITE BLACK OWNER S NAME BROWN OTHER - INDICATE STREET or R.D. CITY STATE ZIP CODE PA TOWNSHIP/BOROUGH MICROCHIP-IMPLANTING COUNTY SCANNING SELECT.

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