End of life services

The Dignity Endowment is a fund HAVA established to assist qualified low-income people with euthanizing a pet when they are elderly, ill, or injured; that is the best or only recourse for the pet.

The average cost of euthanasia in Pacific County is $65 for a cat, and will vary by weight for dogs, $75-175. There are additional fees of $10-25 per pet, depending upon what an owner chooses to do with the body. Unfortunately, we are not able to offer assistance with cremation, as the goal of this fund is to make sure no animal has to suffer.

We hope you will join us in helping our community pets leave this world without prolonged pain. This is one of the final and best, gifts we are able to provide our beloved companions when it’s time.

STEPS IN THIS PROCESS

1. Review the qualifications below to make sure you qualify.
2. Submit an application. (one for each pet)
3. Mail your “income proof” & co-pay payment to:
   HAVA
   PO BOX 243
   Raymond, WA 98577
4. You will be notified when you have been approved and HAVA will provide you with a voucher.
5. Contact one of our approved vets to schedule the appointment
6. Procedure is performed and the vet will bill HAVA for the euthanasia fee.
   HAVA does not cover any additional costs.

QUALIFICATIONS

This program is limited to pet owners who are financially unable to pay to euthanize their pet. You must meet the following household income qualifications in order to qualify. You will need to mail a copy of your “proof of income” to HAVA. Our mailing address is PO BOX 243, Raymond, WA 98577. If you are not sure if you qualify, please call us at (360) 942-4716 and we will let you know.

ACCEPTABLE LOW INCOME DOCUMENTATION:

• Wage Statement/Paycheck Stub
• SSI/SSDI Statement
• Approval Letter for Cash Aid
• Approval Letter for DSHS Medical Coupons
• Unemployment Statement
• L & I Statement
• Approval Letter for Food Stamps

PARTICIPATING VETERINARIANS:

Country Pet Vet: 300 Parpala Rd Naselle (360) 484-7228
Vetters Animal Hospital: 2400 Ocean Ave Raymond (360) 942-3440
Willapa Veterinary Services – Raymond: 230 Ocean Ave Raymond (360) 942-2321
Willapa Veterinary Services – Grayland: 2012 State Road 105 Grayland (360) 267-4444 

PLEASE COMPLETE ONE FORM PER PET.

Dignity Endowment Application

Please enable JavaScript in your browser to complete this form.

1About you

2About your pet

3Low-income Documents & Acknowledgement

Your Name *

First

Last

Are you over 18? *

• Yes
• No

Unfortunately, this form requires someone over 18 to qualify for this assistance program.

Email *

Phone *

Mailing Address *

Address Line 1

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Different Physical Address

• My Mailing address and physical address are the same.

Physical Address *

Address Line 1

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Next

Is this animal YOUR pet? (You own it) *

• Yes
• No

Please provide details: *

Your pet's name *

Is it a cat or a dog? *

• Cat
• Dog

What is the gender? *

• Female
• Male
• Unknown

Select your dog's weight range: *

• Less than 30lbs
• Greater than 30lbs

Breed and description: *

Please tell us if your pet is ready to pass due to old age, illness, or accident: *

Has your pet seen a vet recently? *

• Yes
• No

Please select one of the approved vets you will use: *--Select One--Willapa Veterinary ServicesVetters Animal HospitalCountry Pet Veterinary Clinic

Do you already have an appointment for the procedure? *

• Yes
• No

When is the the appointment? *

Date

Time

Next

You are required to submit evidence of low income to qualify for this program. Below are acceptable documents.

• Wage Statement/Paycheck Stub
• SSI/SSDI Statement
• Approval Letter for Cash Aid
• Approval Letter for DSHS Medical Coupons
• Unemployment Statement
• L & I Statement
• Approval Letter for Food Stamps

Please upload your evidence

Click or drag files to this area to upload. You can upload up to 2 files.

Acceptable document types: pdf, jpg, png
Note: If you are unable to upload, you can email it to hava@hava-heart.org or mail it PO BOX 243, Raymond, WA 98577

By submitting this application you certify all the information provided on this application is accurate.

Sign & Submit