Village of Richfield Dog License Application
Chapter 95, section 95.21(20)(A) of Wisconsin Law requires your dog to be vaccinated for rabies within
30 days after it is 5 months old.
License will not be issued if dog does not have a current rabies shot and you will be reported as having a delinquent dog.
Instructions: Fill out your pet(s) information on the reverse side of this form. Once the application is completed, a copy of your
rabies certificate must be present along with method of payment. Cash or check are accepted.
All pets must be licensed by March 31
st
for the current year.
Costs: Pets who have been spayed or neutered cost $10 per pet. All pets who are not spayed or neutered cost $20 per pet, per license.
A late fee of $5 will be imposed for each pet licensed after March 31
st
.
Payment Options: Pet licensing applications can be mailed-in, dropped-off, or brought in to Village Hall, located at 4128 Hubertus Rd.,
Hubertus, WI. Hours of operation are 7:30AM-4:00PM M-F.
Please issue separate forms of payment if submitting with tax and/or permit payment.
If applying by mail, enclose a self-addressed stamped envelope
Office Use:
Owner’s name:_____________________ Phone:______________________ Date:__________ Payment: Cash/Check ________
Address: _______________________________________________________________________ Late Fee: Yes_____ No____
Veterinarian Clinic:_________________________________ Phone: _________________________ Tag #____________________
Name: _____________________________
Name: _____________________________
Name: _____________________________
Breed:______________________________
Breed:______________________________
Breed:______________________________
Color: ______________________________
Color: ______________________________
Color: ______________________________
Gender: M/MN/F/FS (circle one)
Gender: M/MN/F/FS (circle one)
Gender: M/MN/F/FS (circle one)
Rabies Expiration: ___________________
Rabies Expiration: __________________
Rabies Expiration: ___________________
Rabies Manufacturer: ________________
Rabies Manufacturer: ________________
Rabies Manufacturer: ________________
Rabies Serial No.: ____________________
Rabies Serial No.: ____________________
Rabies Serial No.: ____________________
Chip Number: _______________________
Chip Number: _______________________
Chip Number: _______________________
