Type Full Name :
Sign With Hand
Last Name
If Other Breed, specify
Required Documents
Vaccination Information
Owner Information
Sex *
Age *
Phone # *
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 December 31st of the licensing year.

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

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

Address *
50 Winfield Scott Plaza
Elizabeth, NJ 07201
(908) 820-4178
elizabethnj.org
Debarked *
Hair Length *
Address of Vaccination *
Applicant Signature *
Dog License Application
First Name *
Expiration Date *
City of
Elizabeth
First Name
Is Valid?
If applicable, provide details of another owner for this dog that resides at the same address.
Veterinarian Information
Last Name *
Dog Name *
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. I acknowledge that if no payment is made within seventy two (72) hours of this application, it will be deemed null and void, and I will be required to make a new application.
Phone #
Spayed/Neutered? *
Note that payment must be received in full before a Dog License and Registration Tags can be issued.
License Fee
Vaccination Date *
Email *
Full Address *
Dog Information
Name *
Certification
Breed *
Address 2
Service Dog? *
Pet Size *
Email
Previous License Number (if known)
Specify Address where BOTH Dog and Owner reside *