Type Full Name :
Sign With Hand
Last Name
City
If 'Other' Breed, specify
Required Documents
Vaccination Information
Size
Owner Information
Sex
Age
Phone #
Rabies Vaccination Exempt?
Color
Dog License
State
Phone #
  1. Current rabies certificate.
  2. Spayed/Neutered certificate (first time only).
  3. Picture of the dog (Optional).
Address 2
Address
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
1385 US Route 22 East
{[CITY]}, {[STATE]} {[ZIP]}
908-232-2400 ext 270
www.mountainside-nj.com/
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
Pet Information
Name
Certification
Breed
Address 2
Service Dog?
Email
Previous License # (If known)
Specify Address where BOTH Dog and Owner reside