Type Full Name :
Sign With Hand
First Name
Address 2
Phone # *
Specify Address where BOTH Dog and Owner reside *
If "Other", specify
Required Documents
State *
Sex *
Age *
If "Other", specify
Is Rabies Vaccination Exempt? *
Dog License Application
Color *
Phone # *
1. New Registrations
All new applicants must include a valid Rabies Certificate and Spayed/Neutered Certificate before a license can be issued.
The Rabies Certificate must be valid through October 31st of the licensing year.

2. Renewals
Renewals must include a valid Rabies Certificate.
The Rabies Certificate must be valid through October 31st of the licensing year.

3. Service Dogs
All applications for Service Dogs must include a valid Service Dog Registration Certificate.

4. Important Notice
Please note that if your pet’s rabies is due on or before October 31st then you must provide a signed note from your vet stating that it is too soon to get an updated vaccine.

Borough of
New Providence
Hair Length *
Applicant Signature *
Expiration Date *
Are all required documents attached to this online application? *
Amount Due
Size *
Is Valid?
Veterinarian Information
Address *
Email
First Name *
Last Name
ZIP *
Dog's Name *
Dog Fee:
$16.00 if spayed/neutered
$19.00 if not spayed/neutered
I acknowledge that all statements made herein are accurate and that this application will not be accepted as submitted until all required documents are remitted, and all applicable fees are paid.
Phone #
Is this Application for a New Dog or Renewal? *
Is Spayed/Neutered? *
A renewal license must be paid for prior to February 28nd, after that a $5.00 late fee will be charged.
Email *
License Fee
Vaccination Date *
If applicable, provide details of another owner for this dog that resides at the same address.
Address *
Dog Information
Hospital Name *
Certification
Documents
Owner Information
Breed *
Last Name *
360 Elkwood Avenue
New Providence, NJ 07974
Tel: (908) 665-1400 ext.0 | Fax: (908) 665-9272
www.newprov.org
Is a Service Dog? *
Vaccination Information
Previous License Number (if known)
City *