Dog License - TOWNSHIP OF LIVINGSTON HEALTH DEPARTMENT by keara

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									TOWNSHIP OF LIVINGSTON HEALTH DEPARTMENT
204 HILLSIDE AVENUE
LIVINGSTON, N.J. 07039
TEL (973) 535-7961 FAX (973) 535-3234
If animal is deceased or no longer owned
please check box and return form
j □
LICENSE NO.
DOG PARK TAG NO.
DATE ISSUED
N.J. ANIMAL LICENSE
RABIES EXPIRES
r ANIMAL NAME]
AGE
BREED
SPAYED/NEUTERED (YES or NO) VETERINARIAN
SEX
TELEPHONE NO
COLOR
HAIR
§
|
I
SPAYEO
NEUTERED
NON-SPAYED "Y
NOK-NBiTERED
DESCRIPTION
O
s
5 15.00
5 500
51000
520 00
LICENSE FEE
LATE FEE - MARCH 1st
DOG PARK PASS: Resident
DOG PARK PASS: Non-Resident
520.00
w
I
N
5
5 5.00
I
E
51000
S20 00
I
R
§
I
RABIES VACCINATION MUST BE VALID
- TO OCTOBER 31 OF UCENSING YEAR
SUBMIT CURRENT RABIES CERTIFICATE IF EXPIRED
SUBMIT SPAY/NEUTER CERTIFICATE IF NOT ON FILE
I
Email:
TELEPHONE:
S
i
THIS LICENSE EXPIRES JANUARY 31 AND MUST BE RENEWED IN JANUARY OF NEXT YEAR
RETURN ALL COPIES INSTRUCTIONS ON REVERSE SIDE
TOWNSHIP OF LIVINGSTON HEALTH DEPARTMENT
204 HILLSIDE AVENUE
LIVINGSTON, N.J. 07039
TEL (973) 535-7961 FAX (973) 535-3234
If animal is deceased or no longer owned
please check box and return form
J □
LICENSE NO.
DATE ISSUED
DOG PARK TAG NO.
N.J. ANIMAL LICENSE
F ANIMAL NAME
■..BREED
RABIES EXPIRES
SPAYED/NEUTERED (YES or NO) I VETERINARIAN
SEX
HAIR
COLOR
TELEPHONE NO
i
NON-SPAYED T
NON-NBJTERED
SPAYEO
NEUTERED
515.00
5 500
S1000
520 00
DESCRIPTION
O
i
w
LICENSE FEE
LATE FEE - MARCH 1st
DOG PARK PASS: Resident
DOG PARK PASS: Non-Resident
S20.00
S
N
5 500
E
S
S1000
S20 00
1
R
eit
I
RABIES VACCINATION MUST BE VALID
- TO OCTOBER 31 OF UCENSING YEAR
SUBMIT CURRENT RABIES CERTIFICATE IF EXPIRED
SUBMIT SPAY/NEUTER CERTIFICATE IF NOT ON FILE
Email:
TELEPHONE:
I
o
THIS LICENSE EXPIRES JANUARY 31 AND MUST BE RENEWED IN JANUARY OF NEXT YEAR
RETURN ALL COPIES INSTRUCTIONS ON REVERSE SIDE
TOWNSHIP OF LIVINGSTON HEALTH DEPARTMENT
204 HILLSIDE AVENUE
LIVINGSTON, N.J. 07039
TEL (973) 535-7961 FAX (973) 535-3234
If animal is deceased or no longer owned
please check box and return form
J □
LICENSE NO.
N.J. ANIMAL LICENSE
DATE ISSUED
DOG PARK TAG NO.
'■ ANIMAL NAME
BREED
RABIES EXPIRES
AGE
HAIR
SPAYED/NEUTERED (YES or NO) VETERINARIAN
SEX
COLOR
TELEPHONE NO
s
I
NON-SPAYED
NON-NEUTERED
SPAYED
NEUTERED
DESCRIPTION
O
s
W
LICENSE FEE
LATE FEE ■ MARCH 1st
DOG PARK PASS: Resident
DOG PARK PASS: Non-Resident
S20.00
S 500
S1000
520.00
5 15.00
5500
51000
520.00
|
N
1
E
R
O
1
RABIES VACCINATION MUST BE VALID
- TO OCTOBER 31 OF LICENSING YEAR
SUBMIT CURRENT RABIES CERTIFICATE IF EXPIRED
SUBMIT SPAY/NEUTER CERTIFICATE IF NOT ON FILE
i
TELEPHONE:
Email:
£
g
THIS LICENSE EXPIRES JANUARY 31 AND MUST BE RENEWED IN JANUARY OF NEXT YEAR
RETURN ALL COPIES INSTRUCTIONS ON REVERSE SIDE
INSTRUCTIONS:
1.	Check application for accuracy and make any necessary corrections.
2.	Check rabies information and neuter status. If there have been any changes since last billing, be sure to enclose
required certificates.
3. RETURN ALL COPIES OF THIS APPLICATION WITH A SELF-ADDRESSED STAMPED ENVELOPE. ALONG WITH
YOUR CHECK OR MONEY ORDER PAYABLE TO TOWNSHIP OF LIVINGSTON FOR APPROPRIATE AMOUNT.
4.	In order to utilize the Livingston Dog Park, all dogs must wear a Livingston Dog Park Pass. Use this form to apply for
the pass by completing the information on the front of this application and include the appropriate fee for your Livingston
Dog License and the Dog Park Pass. You must have a current year Dog License from your municipality to apply for a
Dog Park Pass. By signing below I agree to the release of Liability statement as well as the Rules of the
Livingston Dog Park that appear on the www.livinastondoaoark.com web site.
5.	Replacement Tags for Animal License S5.00
Signed:
All State Registration Fees And Surcharges Are Included
TOWNSHIP OF LIVINGSTON - HEALTH DEPARTMENT
Date
INSTRUCTIONS:
1.	Check application for accuracy and make any necessary corrections.
2.	Check rabies information and neuter status. If there have been any changes since last billing, be sure to enclose
required certificates.
3.	RETURN ALL COPIES OF THIS APPLICATION WITH A SELF-ADDRESSED STAMPED ENVELOPE. ALONG WITH
YOUR CHECK OR MONEY ORDER PAYABLE TO TOWNSHIP OF LIVINGSTON FOR APPROPRIATE AMOUNT.
4.	In order to utilize the Livingston Dog Park, all dogs must wear a Livingston Dog Park Pass. Use this form to apply for
the pass by completing the information on the front of this application and include the appropriate fee for your Livingston
Dog License and the Dog Park Pass. You must have a current year Dog License from your municipality to apply for a
Dog Park Pass. By signing below I agree to the release of Liability statement as well as the Rules of the
Livingston Dog Park that appear on the www.livinastondoaoark.com web site.
5.	Replacement Tags for Animal License $5.00
Signed:
All State Registration Fees And Surcharges Are Included
TOWNSHIP OF LIVINGSTON - HEALTH DEPARTMENT
Date
INSTRUCTIONS:
1.	Check application for accuracy and make any necessary corrections.
2.	Check rabies information and neuter status. If there have been any changes since last billing, be sure to enclose
required certificates.
3. RETURN ALL COPIES OF THIS APPLICATION WITH A SELF-ADDRESSED STAMPED ENVELOPE. ALONG WITH
YOUR CHECK OR MONEY ORDER PAYABLE TO TOWNSHIP OF LIVINGSTON FOR APPROPRIATE AMOUNT.
4.	In order to utilize the Livingston Dog Park, all dogs must wear a Livingston Dog Park Pass. Use this form to apply for
the pass by completing the information on the front of this application and include the appropriate fee for your Livingston
Dog License and the Dog Park Pass. You must have a current year Dog License from your municipality to apply for a
Dog Park Pass. By signing below I agree to the release of Liability statement as well as the Rules of the
Livingston Dog Park that appear on the www.livinastondoaDark.com web site.
5.	Replacement Tags for Animal License $5.00
Signed:.
Date	
All State Registration Fees And Surcharges Are Included
TOWNSHIP OF LIVINGSTON - HEALTH DEPARTMENT

								
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