Medford Township Clerk’s Office

Dog License Form

17 North Main Street

Medford, New Jersey 08055

** This form is for new dogs and new residents.

Name of Dog: ________________________________________________

Owner Name: ________________________________________________

Owner Address: ________________________________________________

________________________________________________

________________________________________________

Phone Number: ( ) -

Sex of Dog: Male Female

Age: _______ years

Breed: _________________________________________________

Hair Color: _________________________________________________

Hair Length: Short Medium Long

Is the dog Spayed or Neutered? Yes No

Rabies Expiration Date: ______________________________________________

Veterinarian’s Name: _________________________________________________

Fees: Prior to Jan. 31^st After Jan. 31^st

Spayed or Neutered $12.00 $27.00

Not Spayed or Neutered $15.00 $30.00

**New dogs and new residents do not get charged late fees.

Notes:

1. Make checks payable to “Township of Medford”

2. You must provide proof of rabies vaccination valid through November 1^st of

the current year along with proof of spaying/neutering.

3. If mailing, don’t forget to include a self addressed, stamped envelope.