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2. 
3. DOG LICENSE APPLICATION

5. Any person who owns, keeps, or harbors a dog over the age of 6 months within the municipality shall, within 30 days after acquisition of the dog, be required to license the dog with the City of Fairbury by City Ordinance § 94.45. Dog licenses expire December 31 of each year. A penalty is applied for each pet after January 10.

8. Licenses are issued by the City of Fairbury upon submission of:

   1. Completed Dog License Application
   2. Presentation of a Current Rabies Certificate signed by the Veterinarian
   3. Spay or Neuter Verification
   4. Payment of License Fee for Each Neutered/Unneutered Dog (not to exceed 3 dogs)
10. Name*
11. Street Address*
13. Telephone Number*
14. Email Address
15. Veterinarian Office & Phone Number*
17. Check all that apply:

    1. Dog NOT spayed/neutered: $10.00
    2. Spayed/Neutered Dog: $5.00
    3. Additional Dog NOT spayed/neutered: $5.00
    4. Additional Spayed/Neutered Dog: $5.00
    5. Replacement Tag: $5.00
18. Registration after January 10 assesses a $5 .00 late fee:

    1. Dog NOT spayed/neutered): $15.00
    2. Spayed/Neutered Dog: $10.00
    3. Additional Dog NOT spayed/neutered: $10.00
    4. Additional Spayed/Neutered Dog: $10.00
20. Dog #1 Name*
21. Breed/Color*
22. Rabies Tag #*
23. Rabies Expiration Date*
25. Dog #2 Name
26. Breed/Color
27. Rabies Tag #
28. Rabies Expiration Date
30. Dog #3 Name
31. Breed/Color
32. Rabies Tag #
33. Rabies Expiration Date
35. Special Markings/Notes
37. Signature
38. Date*
40. **********TO BE COMPLETED BY CITY OFFICE PERSONNEL ONLY********
42. City Tag Number Issued For Dog #1
43. City Tag Number Issued for Dog #2
44. City Tag Number Issued for Dog #3
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

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50. Submit Submit and Print

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