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2. 
4. Owner's Full Name*
5. Address*
7. Email Address*
8. Phone Number*
12. Name of Pet (Dog/Cat)*
13. Color*
14. Breed*
15. M/F*
    -- Select One --Male - NeuteredMale - UnneuteredFemale - SpayedFemale - Unspayed
17. Vacc. Certification #*
18. Vaccination Date*
    Vaccination Date
19. Expiration Date*
    Expiration Date
20. Age
24. Name of Pet (Dog/Cat)
25. Color
26. Breed
27. M/F
    -- Select One --Male - NeuteredMale - UnneuteredFemale - SpayedFemale - Unspayed
29. Vacc. Certificate #
30. Vaccination Date
    Vaccination Date
31. Expiration Date
    Expiration Date
32. Age
36. Electronic Signature Required*

    1. Yes

37. Pet License & Tags Will Be Mailed to Registered Residence

    The fee for a dog or cat license is FREE. 

    Each license shall expire on December 31 of the year for which the license is issued.

    No person shall own or harbor, at any one time in the Village, more than two dogs or cats of licensing age. (Ord. 321A.  Passed 4-22-69; 1976 Code 4-33.)

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41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field