[The following is the text from the Service Dog Affidavit in a format which can be used by text-to-
voice software.]

Application for Animal License Exemption for Service Animals
(Pursuant to Virginia Code § 3.2-6528)
CITY OF VIRGINIA BEACH CITY TREASURER'S OFFICE

To be completed by the applicant:
I, the undersigned, have a disability which requires the assistance of a service animal. My service 
animal is trained and serves as a [indicate one]:
Guide dog defined as a dog trained to guide an individual with impaired vision;
Hearing dog defined as a dog trained to alert its owner by touch to sounds of danger and sounds to 
which the owner should respond; or
A service dog for a mobility-impaired individual defined as a dog trained to accompany its owner for 
the purpose of carrying items, retrieving objects, pulling a wheelchair; or other such activities 
of service or support including: [list activities]

I, THE UNDERSIGNED, DO HEREBY CERTIFY AND ATTEST THAT THE ANSWERS GIVEN ABOVE ARE CORRECT TO THE 
BEST OF MY KNOWLEDGE AND THE AFOREMENTIONED ANIMAL IS A SERVICE ANIMAL AS PROVIDED BY VIRGINIA CODE 
§ 3.2-6528 AND APPLICABLE FEDERAL LAW.
Signature
Date

If licensing at the Treasurer's Office, this form must be signed and dated in the presence of the 
Treasurer's Clerk.