Borough of Madison
Board of Health
28 Walnut Street
(973) 593-3079 Ext. 1

2008 APPLICATION FOR DOG/CAT LICENSE 
 ALL DOG/CAT LICENSES ARE SUBJECT TO RENEWAL DURING JANUARY

OWNER: 
Name                                                                                                                                        

Phone No.                                                                                                                               

Address_____________________________________________________________ 

DOG/CAT:   Name____________________________________________Age_______________

Hair Length                             S                            M                     L                            

Sex_______ Breed____________________________ 

Color__________________________   

FEE:  License, Registration, State Pilot Fund $ 15.00
Unaltered Dog/Cat (additional $3.00) $18.00
Late charge effective February 1  
$ 10.00 

RABIES VACCINATION MUST BE VALID AT LEAST UNTIL OCTOBER 31, 2008

NEW LICENSE:
Forward rabies certificate & proof of spaying/neutering, if applicable

RENEWALS:
Rabies certificate required if vaccination expires before OCT 31, 2008

MAKE CHECKS PAYABLE TO:
Borough of Madison

MAIL CHECK TO:
Department of Health, 28 Walnut Street, Madison, New Jersey 07940