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. There is a $4 processing fee to submit this application
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
Format: (000) 000-0000.
Dog's Name/Breed

NameBreed
Dog's Gender
Date of Birth (month & year)
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
2 digit month, 2 digit day, 4 digit yearDate
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 Lot#
Rabies Vaccine-Veterinarian's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Dog Spayed or Neutered?
If Yes, Please submit supporting documents
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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.Format: (000) 000-0000.
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.
You MUST Upload Spay/Neuter &/or Rabies Documents

Cancelof
Please Choose a payment option:
Choose category and number of years:
prevnext( X )
Spayed or Neutered, Any Age
Choose below the number of years you would like to purchase

$8.50 Years



NON-Spayed or Neutered, OVER 4 months
Choose below the number of years you would like to purchase

$34.00 Years



NON-Spayed or Neutered, UNDER 4 months old
Choose below the number of years you would like to purchase

$8.50 Years



Processing fee
$4.00



Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

NYC DOG LICENSE APPLICATION FORM

INSTRUCTIONS

Choose category and number of years:

Payment Methods