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2. Name (First & Last)*
3. Phone*
4. Number of Dogs*
   -- Select One --1234
6. Address (location where dogs are kept)*
8. City
9. State
10. Zip
12. Fees
    There is a $0.50 charge to mail your dog tags to you (to cover postage & supplies). It is $0.50 whether you have 1 or 4 dogs. If you do not wish to pay the mailing cost, you will need to stop at Village Hall to pick up your dog license. Licensing fees for each dog are listed in the "Sex Type" dropdown menu. Before you click "Submit", please make sure you know the total owed, as you will need to enter it on the credit card processing site. Example: You need to license two dogs, one female and one neutered male. The total fees would be $23.50 ($0.50 mailing + $15 female + $8 neutered male)
14. Individual Dog Information
    All information below is required for each dog. Submissions with missing information will not be processed. If you are submitting information on a new dog, or a dog with an updated Rabies Certificate, you must be able to scan the Rabies Certificate to be able to complete your application online. If you cannot scan, you may provide the Rabies Certificate by dropping off or faxing (565-4879) a copy to Village Hall.
18. Dog #1 - Name
19. Dog #1 - Color(s)
20. Dog #1 - Breed
22. Dog #1 - Sex Type
    -- Select One --Female - $15Spayed Female - $8Male - $15Neutered Male - $8
23. Veterinarian (Business Name)
25. Rabies Certificate
    Please attach the Rabies Certificate, not the invoice showing payment for rabies vaccination.
29. Dog #2 - Name
30. Dog #2 - Color(s)
31. Dog #2 - Breed
33. Dog #2 - Sex Type
    -- Select One --Female - $15Spayed Female - $8Male - $15Neuetered Male - $8
34. Veterinarian (Business Name)
36. Rabies Certificate
    Please attach the Rabies Certificate, not the invoice showing payment for rabies vaccination.
40. Dog #3 - Name
41. Dog #3 - Color(s)
42. Dog #3 - Breed
44. Dog #3 - Sex Type
    -- Select One --Female - $15Spayed Female - $8Male - $15Neutered Male - $8
45. Veterinarian (Business Name)
47. Rabies Certificate
    Please attach the Rabies Certificate, not the invoice showing payment for rabies vaccination.
51. Dog #4 - Name
52. Dog #4 - Color(s)
53. Dog #4 - Breed
55. Dog #4 - Sex Type
    -- Select One --Female - $15Spayed Female - $8Male - $15Neutered Male - $8
56. Veterinarian (Business Name)
58. Rabies Certificate
    Please attach the Rabies Certificate, not the invoice showing payment for rabies vaccination.
Leave This Blank:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit Submit and Print

* indicates a required field