RETURN TO:				FEES:			

Mt. Olive Health Dept.		Altered:     $8.20

P.O. Bo 450			Unaltered:   $11.20

Budd Lake, N.J. 07828		Late Fee:    $2.00 per

				               month after 1/31

Make checks payable to “Mt. Olive Township

PLEASE PRINT THE FOLLOWING INFORMATION:

OWNER_______________________________________________PHONE__________________

ADDRESS____________________________________________________________________



MAILING ADDRESS (If different)_____________________________________________

DOG’S SEX: (M)  (F)  NEUTERED: (Y)  (N) SPAYED (Y)  (N)  COLOR:____________  



BREED:__________________________________  AGE:_____  LENGTH OF HAIR (L)  (S)  



DOG’S NAME:_____________________________**DATE OF RABIES INNOC:____________

**The state of N.J. requires written proof of current rabies vaccination. The vaccination must be good for the duration of the license issued. Written proof of spaying or neutering will be needed for price reduction. Please mail copies with this form when applying. For additional information, contact Animal Control Officer W. Cirone at 691-0900, Ext. 334.

Owners  Signature __________________________________