Type Full Name :
Sign With Hand
{[ADDR]}
{[CITY]}, {[STATE]} 05701
{[PPHONE]}
{[AWEBSITE]}
Last Name
City
If Other Breed
Required Documents
Vaccination Information
Size
Owner Information
Sex
Age
Phone #
Rabies Vaccination Exempt?
Color
{[PNAME]}
State
Phone #

Proof of rabies vaccination valid through the licensing year must be provided along with proof of neutering or spaying. Please add the Volunteer ID requirements if you are 1st Aid or Fire Dept.

Address 2
Address
Hair Length
Applicant Signature
Rabies Tag #
First Name
Expiration Date
Licensing a Pit Bull?
ZIP
Total Fee:
Volunteer Brielle Fire Dept or 1st Aid?

Note that payment must be received in full before a Dog License and Registration Tags can be issued. Please note that applications submitted or payments made after April 1st will incur a late fee of $5

Type Fee
Spayed/Neutered Dog $12.00
Non-Spayed / Non-Neutered $15.00
Late fee (Renewals after March 31st) $5.00
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?
Secondary Phone #
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