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2. License Type*

   1. New
   2. Renewal
4. Name of Owner*
5. Last Name*
7. Owner Address*
8. Moorestown, NJ 08057
10. Phone Number
11. Mobile Number
12. Email
14. Is the Mailing Address the same as the Owner Address?*

    1. Yes
    2. No
16. If no, list mailing address below
18. Are you a "Covered Person" under "Daniels Law?"*

    1. Yes
    2. No
22. Dog's Name
24. Breed
25. Dog's Date of Birth
27. Colors/Special Markings
29. Rabies Expiration Date
31. Sex

    1. Female
    2. Male
32. Size

    1. Small
    2. Medium
    3. Large
33. Hair

    1. Short
    2. Medium
    3. Long
35. Is your dog spayed/neutered?*

    1. Yes
    2. No
36. Tattoo/Microchip Number
38. Date of Spay/Neuter
40. Veterinarian
41. Vet Phone Number
45. Did you lose a dog that was previously licensed in Moorestown (due to relocation or death)?

    1. Yes
    2. No
47. If so, provide dog's name
49. Owner's Name
50. Last Name
52. Owner's Address
54. City
55. State
56. Zip
58. Dog's Name

60. Please note that State law prohibits municipalities from issuing licenses if the rabies expiration is prior to November of the licensing year (i.e., prior to November 1 this year). If your rabies certificate expires prior to November 1, you must obtain a new certificate prior to obtaining a license or you must provide a "Certificate of Exemption from Rabies Vaccination." 

62. Fees
    Renewals and new licenses bought in January will be $14 for spayed/neutered pets and $17 for non-spayed/neutered pets.
    
    Renewal licenses bought in February or March will be $23 for spayed/neutered pets and $26 for non-spayed/neutered pets.
    
    Renewal licenses bought after March will be $28 for spayed/neutered pets and $31 for non-spayed/neutered pets.

64. Please print this form and mail with:

    1. A check made payable to Moorestown Township

    2. A Certificate of Rabies

    3. A Certificate of Spay/Neuter

    4. A self-addressed, stamped envelope to: Dog Licensing, Township of Moorestown, 111 West Second Street, Moorestown, New Jersey 08057.

    If you have any questions, please call 856-235-0912.

66. Are you a "Covered Person" under "Daniels Law?"*
    -- Select One --YesNo
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field