Dog License Application (PDF)

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Connecticut 
Dog License Application 
Annie Blumenfeld 
Fairfield Warde High School 
Did You Know? 
lilT All dogs over six months must be licensed. 
!ilT All dogs must be licensed by the 30th of June 
of each year. A one dollar fee will be charged 
for each month late. 
lilT All dogs must have a current rabies 
vaccination. 
. 
lilT A license is a lost ·dog's ticket home. 
!ilT Licensing provides vaccination and 
sterilization benefits for pets. 
!ilT Heartworm disease in dogs is preventable. 
Talk to your veterinarian. 
· Application
Name 
Street 
City 
State 
Zip 
Telephone Number 
( 
) 
Dog's Name 
Predominant Breed 
Color 
Dog's Date of Birth 
FEE SCHEDULE (Please check one) 
D Male/Female 
$19.00 
·□ Male Neutered
$ 8.00 
D Female/Spayed
$ 8.00 
Amount enclosed 
$ __ _ 
Please mail a copy of the following with this 
application: 
D Rabies Vaccination Certificate 
D Spay/Neuter certificate (if applicable) 
No_te: Applicants must include a self-addressed
stamped envelope. Please mail this application to 
your local Town Clerk 
For more information, please contact jrour Town 
Clerk or Municipal Animal Control Officer. 
THIS FORM MAY BE REPRODUCED. 
Provided as a cotutesy by the Connecticut Department of Agriculture. 
Rev. 1/2015