Owner:*

Current Address:*

Phone Number:*

Type:*

Cat

Dog

Village Tag No. (Office Use Only)

Pet's name:*

Breed:*

Color:*

Sex:*

Male

Female

Micro Chip:*

Yes

No

Rabies Number:*

Issuing County:*

Cook

Lake

Vaccination Expiration Date: *

A copy of the rabies certificate must be included with the application. Copies will not be returned.

Checks should be made payable to Village of Buffalo Grove.

Please send application with payment and a copy of the rabies certificate to:

Village of Buffalo Grove
Attn: Animal Tags
50 Raupp Blvd
Buffalo Grove, IL 60089