MUNICIPAL CLERK’S OFFICE - Estell Manor, New Jersey



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All dogs over 7 months of age are required to be licensed annually in New Jersey.

1. YOUR NAME: _____________________________________________ /ADDRESS:_________________________________________________

(IMPORTANT! YOU MUST PROVIDE ACTUAL PHYSICAL ADDRESS!)

MAILING ADDRESS:__________________________________________________

TELEPHONE: ________________________________________________________

HAS THE ABOVE INFORMATION CHANGED SINCE LAST YEAR? ( ) YES ( ) NO

2. YOUR DOG’S INFORMATION (use another form if licensing more than 4 dogs):

|PET’S NAME |NEW DOG or RENEWAL? |RABIES CERTIFICATE EXPIRATION DATE |SPAYED OR NEUTERED? YES/NO |*FEE |

| |*must complete additional info below for |*must NOT expire before 10/31 of the |*if yes, include date & proof of |$10.00 IF YES / |

| |new dogs |licensing year |spay/neutering (first time only) |$15.00 IF NO |

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| | | |TOTAL DUE: |$ |

*Please submit a separate payment for pet licensing – Do not combine with tax payments. A LATE FEE IN THE AMOUNT OF $20.00 WILL BE CHARGED FOR RENEWALS SUBMITTED AFTER MARCH 31st.

Please complete for all NEW pets ONLY.

PET’S NAME |BREED |SEX M/F |COLOR/MARKING |HAIR LENGTH

(short/medium/long) |BIRTHDATE

/AGE |APPROX.

WEIGHT | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |

MAIL THIS COMPLETED APPLICATION, ALONG WITH CURRENT RABIES CERTIFICATE, PAYMENT AND A SELF-ADDRESSED STAMPED ENVELOPE TO ESTELL MANOR CITY HALL, ANIMAL LICENSING, 148 CUMBERLAND AVENUE, ESTELL MANOR, NJ 08319. ALL ORIGINAL DOCUMENTS WILL BE RETURNED TO YOU ALONG WITH YOUR LICENSE.

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