NYS RR076
Low Cost/Low Income Spay Neuter Assistance
This program is for Wyoming County pet owners
who income qualify only!!!
If you would like to be considered for voucher eligibility, please read and then complete the following form in its entirity. Vouchers will be reviewed, and the SNIP Program Coordinator will be in contact with you via email if deemed eligible.
First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
County*
Email*
Home Phone*
Cell Phone
Pet Name*
What species are you requesting to spay or neuter
Sex
Age*
Weight
Cat Breed
Color(s) of Cat
Dog Breed
Color(s) of Dog
Pet Name
Age
Do you currently receive any of the following? Check all that apply
Do you have an award letter for one of the above from NYS/Wyoming County for the current time period
Are you a resident living in Wyoming County, New York State?
Do you have current proof of address that is one of the following?
Other proof of address
Can you please tell us where you learned about our voucher program?
How many other pets and what type, are currently in the home? Are they all spayed/neutered?
Where did you acquire your pet/s that you are applying for?
Have you purchased a voucher with us in the past? * Choose one: Yes No