2. 
6. First Name*

   Enter Owner's First Name

7. Last Name*
   Enter Owner's Last Name
8. Date of Birth
   Date of Birth
10. Street Address*

    Enter Street Address and Apt. Number if Applicable

12. City*
    City
13. State*
    -- Select One --AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPeurto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming
14. Zip Code*
    Zip Code
16. Phone Number*
    Primary Phone
17. Alternate Phone Number
    Alternate Phone
18. Email Address*

    Your Email Address

22. Your Forever Friend's Information
24. Type*
    -- Select One --DogCat
25. Gender*
    -- Select One --MaleFemale
26. Breed*
    Enter Breed
27. Age*
    Enter Pets Age
29. Description/Markings*
    Enter any Description/Markings
31. Pet's Name*
    Enter Pet's Name
32. Clinic Name*
    Enter Clinic Name
33. County*
    -- Select One --KaneDuPageWillCookKendallDeKalbOther
35. Microchip Number
    Enter Microchip Number
    
    If your pet does not have a Microchip, Animal Care & Control charges $15.00 for this service.
36. Proof of Microchip
    Upload a copy of the Microchip Documentation
37. Spayed or Neutered*
    -- Select One --YesNo
38. Proof of Spayed or Neutered
    Upload a copy of the Documented Procedure
40. Rabies Tag Number*

    Enter Rabies Tag Number

41. Copy of Rabies Certificate*

    Upload a copy of the Rabies Certificate

    
    

42. Rabies Vaccine Date*
    Rabies Vaccine Date
43. Rabies Expire Date*
    Rabies Expire Date

    Rabies Expire Date
47. CHANGE OF ADDRESS
    If you change your address you are required to phone our office with your new address. There will be no charge to change this information. You MUST have your tag # available to facilitate this process. PLEASE CONTACT THE ANIMAL CARE & CONTROL DEPARTMENT.
49. CHANGE OF OWNERSHIP OF PET
    If you change ownership of your pet, the tag MUST stay with the pet. You MUST contact our office with the new owner's information.. There will be no charge for this service, however if you receive a pet with no license a new license must be obtained, by you, at the standard fee.
51. LOST YOUR PET'S LICENSE?
    If you lose your pet's license tag, a replacement tag will be issued an assessed fee. THE ANIMAL CARE & CONTROL DEPARTMENT.
    
    FOR ANY QUESTIONS OR PROBLEMS FILLING OUT THIS FORM
    OR ANY OTHER INFORMATION REGARDING ANIMAL CARE & CONTROL CONTACT:
    CITY OF AURORA ANIMAL CARE & CONTROL
    600 S. RIVER ST.
    AURORA, IL 60506
    1-630-256-3630
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field