Dog Licensing Form for Year _______
Licenses are Renewed each January
After January 1st and not before, please return form, fee and proof of current rabies
vaccination from a veterinarian or rabies clinic (Not last years license form) per State
Regulation N.J.S.A. 4:19-15.5
$8.00 per spayed or neutered dog
Delaware Township Animal Licensing
$11.00 per unspayed/non-neutered dog
Attn: Deanna Higgins
P.O. Box 101
Sergeantsville, NJ 08557
(609) 483-2665 ext. 201
____ New Dog
**Rabies Vaccination CAN NOT EXPIRE BEFORE 11/1
or your forms and payment will be sent back to you**
Application is considered incomplete (a late fee may apply, see below)
____Renewal
DOG’S OWNER NAME
Check payable to: Delaware Township or exact cash.
_________________________________________ DATE_________________
MAILING ADDRESS_______________________________________ CITY/STATE/ZIP______________________________________
Must Provide Street Address, No P.O. Boxes STREET LOCATION _______________________________________________________
TELEPHONE _________________________
DOGS NAME: ___________________________
CELL # ___________________________
SEX ________ HAIR ________________ DOG’S AGE __________
(short, med., long)
SPAYED/NEUTERED? ____ YES / ___ NO
Microchip ID # ___________________________________
COLOR/MARKINGS ______________________________
BREED _________________________________________
RABIES EXPIRATION: ATTACH RABIES CERTIFICATE (Cannot Expire Before 11/1/CURRENT YEAR)**
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DOGS NAME: ___________________________
SEX ________ HAIR ________________ DOG’S AGE __________
(short, med., long)
SPAYED/NEUTERED? ____ YES / ___ NO
Microchip ID # ___________________________________
COLOR/MARKINGS ____________________
BREED _________________________________________
RABIES EXPIRATION: ATTACH RABIES CERTIFICATE (Cannot Expire Before 11/1CURRENT YEAR)**
Beginning March 1st (current year), please include an additional $30.00 late fee PER DOG (Ordinance
#2005-26BH) Only exact cash or check is accepted as payment. If proof of rabies is not included or expires before
Nov. 1st of licensing period, the application is considered incomplete and your form and payment will be sent back
to you. Pet owners are responsible for knowing when their pets’ rabies vaccinations expire.
Please call me or list the names of pets you NO LONGER own __________________________ Thank you,
WARNING: Applications received by or sent to Township officials are subject to the Open Public Records Act (OPRA)
DOG’S OWNER NAME
_________________________________________ DATE_________________
DOGS NAME: ___________________________
SEX ________ HAIR ________________ DOG’S AGE __________
(short, med., long)
SPAYED/NEUTERED? ____ YES / ___ NO
Microchip ID # ___________________________________
COLOR/MARKINGS ______________________________
BREED _________________________________________
RABIES EXPIRATION: ATTACH RABIES CERTIFICATE (Cannot Expire Before 11/1/CURRENT YEAR)**
--------------------------------------------------------------------------------------------------------------------------------------
DOGS NAME: ___________________________
SEX ________ HAIR ________________ DOG’S AGE __________
(short, med., long)
SPAYED/NEUTERED? ____ YES / ___ NO
Microchip ID # ___________________________________
COLOR/MARKINGS ____________________
BREED _________________________________________
RABIES EXPIRATION: ATTACH RABIES CERTIFICATE (Cannot Expire Before 11/1/CURRENT YEAR)**
--------------------------------------------------------------------------------------------------------------------------------------
DOGS NAME: ___________________________
SEX ________ HAIR ________________ DOG’S AGE __________
(short, med., long)
SPAYED/NEUTERED? ____ YES / ___ NO
Microchip ID # ___________________________________
COLOR/MARKINGS ______________________________
BREED _________________________________________
RABIES EXPIRATION: ATTACH RABIES CERTIFICATE (Cannot Expire Before 11/1/CURRENT YEAR)**
--------------------------------------------------------------------------------------------------------------------------------------
DOGS NAME: ___________________________
SEX ________ HAIR ________________ DOG’S AGE __________
(short, med., long)
SPAYED/NEUTERED? ____ YES / ___ NO
Microchip ID # ___________________________________
COLOR/MARKINGS ____________________
BREED _________________________________________
RABIES EXPIRATION: ATTACH RABIES CERTIFICATE (Cannot Expire Before 11/1/CURRENT YEAR)**
--------------------------------------------------------------------------------------------------------------------------------------
DOGS NAME: ___________________________
SEX ________ HAIR ________________ DOG’S AGE __________
(short, med., long)
SPAYED/NEUTERED? ____ YES / ___ NO
Microchip ID # ___________________________________
COLOR/MARKINGS ______________________________
BREED _________________________________________
RABIES EXPIRATION: ATTACH RABIES CERTIFICATE (Cannot Expire Before 11/1/CURRENT YEAR)**