Yes No

1 Year 3 Years

New Application Application Initiated Application Denied Payment Requested Payment Received License Issued License Expired Inactive - Dog Died Inactive - Owner Moved Inactive - Other Replacement

Yes No Exempt

Male Female

Small Medium Large

Short Medium Large

Yes No

No Seeing Eye Hearing Dog Service Dog

Yes No

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 *

State

Phone # *

Address *

Age *

Applicant Signature *

Name *

Expiration Date of Vaccination

Secondary Phone #

Name

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.

Licensing

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.

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

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

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

Email *

Address *

City

Size *

Dog Information

Name *

Certification

Breed *

Primary Phone # *

Address 2

ZIP

Email

Specify the Address where BOTH Dog and Owner/Guardian reside *