Type Full Name :
Sign With Hand
Last Name
City
If "Other", specify
Attachments
Vaccination Information
Size
Owner Information
Sex
Amount Due
Age
Phone #
Rabies Vaccination Exempt?
Color
{[PNAME]}
Application
Type Neutered/Spayed Non-Neutered/Non-Spayed
Initial/Renewal Applications $10.00 $15.00
Late Fee (February 15 until May 31st) $5.00 $5.00
Late Fee (June 1st through end of year) $10.00 $10.00
State
Phone #
- Required Documents:
  • Current rabies certificate
  • Spayed/Neutered certificate
Address 2
Address
430 Park Ave
Scotch Plains, NJ 07076
{[APHONE]} ext 211/212
{[AWEBSITE]}
Hair Length
Applicant Signature
Rabies Tag #
First Name
Expiration Date
ZIP
First Name
City
Is Valid?
If applicable, provide details of another owner for this dog that resides at the same address.
Veterinarian Information
ZIP
Last Name
Dog Name
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 pet’s license.
Phone #
Spayed/Neutered?
Application Type
Note that payment must be received in full before a Dog License and Registration Tags can be issued.

License Fee
Vaccination Date
State
Email
Address
Dog Information
Name
Certification
Breed
Address 2
Service Dog?
Email
Previous License # (If known)
Specify Address where BOTH Dog and Owner reside