Type Full Name :
Sign With Hand
If "Other," specify
License Fee
Is a service dog? *
Dog Owner/Guardian Information
Sex *
Name of Microchip Company
Date of Birth
Is the dog exempt from rabies vaccination? *
Color and Markings *
{[CITY]}, {[STATE]} {[ZIP]}
Phone # *
Address *
Age *
Applicant Signature *
Name *
Expiration Date of Vaccination
Secondary Phone #
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.
The following documents must be filed with this appliction:

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.

Phone #
Is spayed or neutered? *
Microchip #
Required Documents
Hair Length *
All applications require a copy of the Rabies Vaccination Certificate showing it to be valid through the license period attached to the application when filed. Rabies Vaccinations must be valid through November 1st of licensing year. Dogs incapable of being inoculated are exempted when certified in writing by a duly licensed veterinarian. Original exemption letter or NJ VPH-28 "CERTIFICATE OF EXEMPTION FROM RABIES VACCINATION FORM" form is required.
Date of Vaccination
Helpful Contacts
Animal Emergencies: The Borough of Manville contracts with the Somerset Regional Animal Shelter, they can be contacted at 908-725-0308.
General Questions: For any other questions about animals, you may contact the Somerset County Board of Health Office at 908-231-7155.
Licenses: For licensing information, you may contact the Manville Borough Board of Health Office at 908-725-9478, ext. 114.

$10 for spay/neuter dog
$13 for non spay/non neuter dog

Late fees for dogs:
$5 after March 1st
$10 after May 1st

Licenses expire on December 31st of each year and become renewable after January 1st of the following year.

Email *
Address *
Size *
Dog Information
Name *
Breed *
Primary Phone # *
Address 2
Specify the Address where BOTH Dog and Owner/Guardian reside *