Type Full Name :

Sign With Hand

City

New Registrations

Rabies Certificate valid through October 31st of the licensing year
Spayed/Neutered Certificate
Proof of rabies exemption if applies

Renewals

Proof of new rabies vaccination (if rabies expires prior to October 31st of the licensing year)

Application Type

Address

Clark Township

Hair Length

Clark Health Department
430 Westfield Ave.
Clark, NJ 07066
732-428-8405, 732-388-3600 ext 3006

Certification

Age

Cat Information

Cat's Name

(If "Yes", Proof of Exemption is Required)

Phone #

Please enter your Street Number and part of the Street Name and select your property from the dropdown list.

Facility Name

Phone #

Last Name

Amount Due:

State

Applicant Signature

Rabies Expiration Date

Previous License Number (if known)

Sex

Address 2

Vaccination Information

Is Spayed/Neutered?

Address

Type	Fee
Spayed/Neutered Cat	$18.00
Non-Spayed/Neutered Cat	$20.00

Please be advised there is a $3.00 processing fee for Credit Card payments.

Please note that you will be contacted upon review of application and documentation, and at that time payment will be requested. Payment can be made via cash, check or credit card.

If "Other", specify

Microchip #

Rabies Tag #

{[PNAME]}

By submitting this form, I am confirming that all of the information I have entered is accurate, according to the best of my knowledge. I understand that failure to provide correct information will result in revocation of my cat’s license.

ZIP

Fee Schedule

Breed

Required Documents

Veterinarian Information

Color

Specify Address where BOTH Cat and Owner reside

First Name

Owner Information

Is Rabies Vaccination Exempt?

Rabies Vaccination Date