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2. Village of Niles - Community Development

   1000 Civic Center Drive, Niles, IL. 600714

   847-588-8040

4. I, The Owner

6. First Name*
7. Last Name*
9. Have control of the property at (enter street address):**
11. Address2*
13. City*
14. State*
15. Zip*
17. Phone Number Where You Can Be Reached:**
19. Email Address*
21. Today's Date
    Today's Date
23. Is this a Rental Property? *

    Please be advised, the Village of Niles does not perform extermination or baiting of rodents in rental properties. 

    1. Yes
    2. No
25. Please provide a description of the problem:**
27. Pet Safety Information

    The meal bait used to treat rodent burrows is extremely toxic to mammals and birds. Dogs, cats and other predatory and scavenging mammals and birds might be poisoned if proper precautions are not taken by pet owners. I will  keep my pets inside and not allow them to roam near the rodent burrows while they are being treated with meal bait.                  

29. Please Check The Box Below:*

    1. Yes, I agree to keep my pets away from burrows while they are being treated.
31. I give my permission to employees of the Village of Niles and/or its contractor, a licensed pest control operator, to come onto the property to do work required to exterminate or to bait for rats. I understand that pesticides may be used in this process. I will do my part by cleaning the yard and removing any bulk items, by not feeding pets outside, and will use my durable refuse carts and keep the lids closed at all times. I also agree to release the Village from any claims or actions arising out of or related to the Community Development Department Rat Control Program.
33. Please Check Box Below:*

    1. Yes, I agree to the terms of this Release of Liability Form.
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field