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2. VILLAGE OF BRIARCLIFF MANOR

   DOG LICENSE APPLICATION

4. ORIGINAL
5. RENEWAL
6. TRANSFER OF OWNERSHIP*
8. LICENSE #:
9. DUE DATE
11. DOG'S NAME:*
12. NEW EXPIRATION DATE
14. SEX:*
15. FEE:
17. BIRTH YEAR:*
18. RABIES IMMUNIZATION CERTIFICATE*
20. BREED*
22. COLOR:*
24. SPAYED/NEUTERED:*
26. SPAYED/NEUTERED CERTIFICATE

    If you are registering your dog for the first time, please submit a copy of the spayed/neutered certificate.

28. OWNER'S NAME*
30. ADDRESS*
32. CITY*
33. STATE*
34. ZIP CODE*
36. EMAIL ADDRESS*
38. PHONE NUMBER*

42. Please make sure you are logged in before submitting.

    
    

    Please note that all licenses expires with dog's rabies vaccination.  

    
    

    Examples for the Year 2026: 

    • If your dog’s rabies vaccination expires in 2027, you may pay for a one year license now.  Then, in 2027 you can choose to renew for either one year or three years, depending on when your dog’s rabies vaccination expires.

    
    

    • If your dog’s rabies vaccination expires in 2028, you may pay for two years by selecting the one year option and entering a quantity of 2.  Then, in 2028 you can choose to renew for either one year or three years, depending on when your dog’s rabies vaccination expires.

    
    

    • Alternatively, you may choose to just pay annually.

44. FEE SCHEDULE (EXPIRES WITH RABIES VACCINATION)
46. One Year
    Options
47. Price
    -- Select One --Unspayed/Unneutered Dog - $25.00Spayed/Neutered Dog - $20.00Unspayed/Unneutered Dog (Residents Over 65) - $15.00Spayed/Neutered Dog (Residents Over 65) - $10.00
48. Quantity
49. Shipping Cost
51. Taxable
53. Three Year
    Options
54. Price
    -- Select One --Unspayed/Unneutered Dog - $75.00Spayed/Neutered Dog - $60.00Unspayed/Unneutered Dog (Residents Over 65) - $45.00 Spayed/Neutered Dog (Residents Over 65) - $30.00
55. Quantity
56. Shipping Cost
58. Taxable
60. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
62. Electronic Signature*
Leave This Blank:


64. Calculate Totals Proceed to Checkout

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