Type Full Name :
Sign With Hand
If "Yes", specify
City
If "Other", specify
License Fee
Service Dog?
Dog Owner/Guardian Information
Sex
Microchip Company
Is the dog exempt from rabies vaccination?
Color
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
State
{[PNAME]}
Vaccination Information
Phone #
Address
Age Years
Applicant Signature
Address 2
First Name
Expiration Date
Specify address where BOTH Dog and Owner reside.
{[CNAME]}
First Name
If applicable, provide the details of another owner that resides at the same address.
Veterinarian Information
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 filed 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.
Last Name
The following documents are required (If Applicable):

Valid Proof of Identification
Such as a State-issued driver's license/ID card, US Passport, military ID card, etc.

Rabies Vaccination Certificate
If the dog is exempt then provide original exemption letter or NJ VPH-28 "CERTIFICATE OF EXEMPTION FROM RABIES VACCINATION FORM" form.

Proof of Surgery
If the dog is spayed or neutered provide proof from the veterinarian.

Service Dog Registration Cerificate
If the dog is a service dog then provide a valid Service Dog Registration Certificate.

Last Name
Phone #
Address 2
Spayed/Neutered?
Microchip #
Required Documents
Hair Length
License Period
License Fee
Vaccination Date
Licenses may be purchased for a period of twelve (12) months or thirty-six (36) months (one (1) year or three (3) years).
Licenses expire on the 30th of April at the end of the license period.
Email
Age Months
Address
City
Size
Dog Information
Name
Certification
Breed
Phone #
Zip
ZIP
Email
State
Has the dog been deemed dangerous?
Application Type
Is Valid?