APPLICATION FOR DOG LICENSE
COUNTY OF ALLEGAN
SALLY L. BROOKS, TREASURER
113 CHESTNUT ST.- PO BOX 259
ALLEGAN, MI 49010-0259
PHONE: 269-673-0260
FAX:
269-673-6094
www.allegancounty.org
E-mail: [email protected]
MICHIGAN LAW REQUIRES THAT DOGS 4 MONTHS AND OLDER MUST BE LICENSED AND WEAR THEIR TAG.
OWNER INFORMATION
Date: _______________
Name: ______________________________________________________________________________
Address: ____________________________________________________________________________
City/State/Zip ________________________________________________________________________
Phone # ________________________ Alternate/Cell Phone: _________________________________
Township/City/Village of Residence _____________________________________________________
DOG INFORMATION
Name . . .
________________________
Date of Birth . . . ________________________________
Sex. . . .
________________________
Rabies Vaccination Expiration Date __________________
Breed . . .
________________________
Veterinarian
Color/Markings . . . _____________________
DOG LICENSE REQUESTED
____________________________________
(Please check)
1 YEAR LICENSE
3 YEAR LICENSE
____________________________________
(with valid 3 yr rabies)
Puppy
12 Months or less
Male/Female
_____ $5.00
______ $10.00
_________
______ $25.00
_________ $12.00
Spayed/Neutered
$5.00
In order to purchase a three license the rabies vaccination has to be valid for three full years.
LICENSES MAY BE PURCHASED OR RENEWED ON LINE AT WWW.MIDOGLICENSE.ORG/ALLEGANCOUNTY
MAIL THIS FORM, VALID RABIES CERTIFICATE, PROOF OF NEUTERING, AND A CHECK OR MONEY ORDER payable to
“ALLEGAN COUNTY TREASURER” for the appropriate fee to the address above. You will receive the Dog License, metal tag, your
rabies certificate and proof of neutering by return mail.
_________________ _______________________________________________________
*State law requires that newly acquired dogs be licensed within 30 days of acquisition.
*Lost tags are replaced free of charge, if a “Lost Tag Affidavit” is filed with this office.
For information on microchip implants or tattoo identification, please contact your local veterinarian, call
the Michigan Department of Agriculture at (517) 241-2748, or visit ww.akccar.org