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2. Pet Name*
3. Age*
4. Sex*
   -- Select One --MaleFemale
5. Neutered or Spayed*
   -- Select One --YesNo
7. Breed*
8. Coat Length*
   -- Select One --ShortMediumLong
9. Color*
11. Rabies Vaccine Expiration Date*

    *Proof of current rabies vaccination must be provided to Health Department

12. Veterinarian*
13. Microchip Number (if applicable)
15. Owner Name*
17. Address*
19. Phone Number*
20. Email *
22. *Important Information for Dog Owners

    Pursuant to N.J.A.C. 8:23A-4.1, the Health Department must be provided with a rabies vaccine certificate valid through October 31st of the current licensing year , in order to issue license.

24. Dog License Fees:

    $10 (neutered/spayed)

    $13 (not neutered/spayed) 

    Cat License Fees: 

    $4 (neutered/spayed)

    $7 (not neutered/spayed). 

    *Neutered/spayed documentation must be provided to Health Department for new licenses.

    Fees are payable by cash or check made out to  the Fort Lee Health Department.

28. 
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field