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2. 
3. Township of Bloomfield

   1 Municipal Plaza – Room 109 Bloomfield, New Jersey 07003-3487 Tel. (973) 680-4024 Fax. (973) 680-4825

4. Date:*
   Date:

   Date:
6. PET LICENSE APPLICATION
   This License will be valid from July 1, through June 30.
7. Please Choose One:

   1. New Application
   2. Renewal Application
8. Please Choose One*
   -- Select One --DogCat
10. Owner Information
11. First Name
12. Last Name
13. Phone Number
15. Email Address
17. Address
19. City
20. State
21. Zip Code
23. Animal Information
25. Name of Pet*
26. Sex of Pet*
27. Birthday / Age*
28. Chip Number
30. Breed
31. Color
32. Hair Length
33. Weight
35. NOTE:
    If your pet's rabies vaccination expires BEFORE May 1, of NEXT YEAR, you MUST get your pet re-vaccinated! If mailing, please include a copy of the rabies vaccination Certificate.
36. Please Choose One:*

    1. Pet IS Spayed / Neutered
    2. Pet IS NOT Spayed / Neutered
38. Rabies Issue Date
39. Rabies Expiration Date:*
40. Vet / Clinic:*
41. Vet Phone Number:*
43. Please bring in a copy of the rabies vaccination certificate with this application:
45. License Information
    FEES: $22.00 for spayed/neutered pets (MUST SUBMIT PROOF OF SPAY/NEUTERING) $25.00 for non-spayed/neutered pets (NOTE: No cash will be accepted)
47. TO OBTAIN A LICENSE FOR YOUR DOG/CAT:

    1. Complete all information requested above, INCLUDING telephone numbers. Your application will not be processed if any information is missing.

    2. Mail a check or money order made payable to the “Township of Bloomfield” in the appropriate amount to:

    Bloomfield Municipal Health’s Office (PET LICENSE) Room 109
     1 Municipal Plaza Bloomfield, New Jersey 07003

49. No cash is accepted. We accept credit and debit card payments in person only. THANK YOU.
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