Type Full Name :

Sign With Hand

City

If Other Breed, specify

Required Documents *

Vaccination Information

License Period

Size *

Dog Owner/Guardian Information

Sex *

Age *

Phone # *

Rabies Vaccination Exempt? *

Color and Markings*

{[PNAME]}

Phone # *

Current rabies certificate
Spayed/Neutered certificate

Address *

Microchip Number

Hair Length *

Applicant Signature *

Rabies Tag #

Name of Microchip Company

Name *

Expiration Date *

{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}

ZIP

Name

Is Valid?

If applicable, provide details of another owner for this dog that resides at the same address.

Veterinarian Information

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.

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

Late fees for dogs:
$10 after May 1st

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

Dog Name *

License Fee

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.

Phone #

Spayed/Neutered? *

Application Type *

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.

Note that payment must be received in full before a Dog Licensing and Registration Tags can be issued.

License Fee

Vaccination Date *

State

Email *

Dangerous Dog

Full Address *

Dog Information

Name *

Certification

Breed *

Address 2

Service Dog? *

Prev. Lic. # (If known)

Specify Address where BOTH Dog and Owner reside *
Enter the street number and street name to Search