NYC Dog License Form

NYC DOG LICENSE APPLICATION FORM

This form is to be used for first time License (NOT renewals)
INSTRUCTIONS
1. Fill out the form.
2. Upload Required Documents.
3. If paying on line there is a $3 processing fee. If paying by check or cash you will be contact to make arrangements
4. You will be notified when your dog's tag is ready for pick up.
5. Questions? Contact Desma at SICDTC@hotmail.com
Owner's Name *

First NameLast Name
Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail *
example@example.com
Mobile Number *
Dog's Name/Breed*

NameBreed
Dog's Gender
Dog Weight (Approx)
Microchip or Tatoo number if applicable
Dog's Primary Color
Dog's Secondary/Third Color (optional)
Has your dog received a Rabies Vaccination?
If Yes, Please submit supporting documents
Date Rabies Vaccine Given

MonthDayYear
Date
Rabies Vaccine Lot#*
Rabies Vaccine -Veterinarian's Name

First NameLast Name
Rabies Vaccine-Veterinarian's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Rabies Vaccine-Veterinarian's Phone Number
Please enter a valid phone number.
Dog Spayed or Neutered?
If Yes, Please submit supporting documents
Date

MonthDayYear
Date
Spay/Neuter-Veterinarian's Name (if different than Rabies)

First NameLast Name
Spay/Neuter -Veterinarian's Address (if different than Rabies)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spay/Neuter-Veterinarian's Phone Number (if different than Rabies)
Please enter a valid phone number.
In submitting this application, I also state that the information I have provided is accurate. I recognize that making false statements in this application violates NYC Health Code section 3.19 and other applicable law and may subject me to civil and criminal fines and penalties, and invalidation of any license issued.

Powered by Jotform SignClear
You MUST Upload Spay/Neuter &/or Rabies Documents*

Cancelof
Please Choose a payment option:

Cash (you will be contacted to make arrangements)Check (you will be contacted to make arrangements)On-line (pay below-$3 Processing Fee included)
ON-LINE PAYMENT OPTION: THERE IS A $3 PROCESSING FEE TO PAY ON-LINE
prevnext( X )
Spayed or Neutered, Any AgeChoose below the number of years you would like to purchase
$8.50 Years



NON-Spayed or Neutered, OVER 4 monthsChoose below the number of years you would like to purchase
$34.00 Years



NON-Spayed or Neutered, UNDER 4 months oldChoose below the number of years you would like to purchase
$8.50 Years



Processing Fee-PLEASE CHECK BEFORE SUBMITTING ON-LINE PAYMENT
$3.00



Total

$0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

NYC DOG LICENSE APPLICATION FORM

INSTRUCTIONS