“The Heartland of New Jersey”

UPPER FREEHOLD TOWNSHIP ANIMAL CONTROL

314 ROUTE 539, CREAM RIDGE, NJ 08514

609-758-7738 ext.224

2012 DOG LICENSE APPLICATION

DATE: ______________________

OWNER’S NAME: ____________________________________________________________

ADDRESS: ___________________________________________________________________

ZIP CODE: _____________________ PHONE NUMBER: ___________________________

EMAIL ADDRESS(optional)_____________________________________________________

DOG’S NAME:___________________________________ SEX: Male ______ Female _____

DOG BREED: ______________________________________ COLOR: __________________

AGE: _______________________ HAIR: Short_______ Medium _______ Long _________

SPAYED/NEUTERED: Yes _________ No _________ (IF YES, PLEASE ATTACH PROOF)

RABIES EXPIRATION DATE: _________________________ PLEASE PROVIDE PROOF

(RABIES CERTIFICATE)

2011 LICENSE # (If applicable)__________________________

Spayed/Neutered-7.50 Non-Spayed/Neutered-10.50 – AMOUNT ENCLOSED: __________

Renewal Licenses Only (New Licenses do not pay a late fee)

**LATE FEE OF $25.00 WILL BE APPLIED AFTER FEBRUARY 16, 20127

** NO EXCEPTIONS**

Please make checks payable to: TOWNSHIP OF UPPER FREEHOLD

THIS LICENSE EXPIRES 12/31/2012 AND MUST BE RENEWED DURING JANUARY 2013