Dog Licenses

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DOG LICENSE APPLICATION

New York State law requires all dogs 4 months or older to be licensed annually. Dog owners are required to have a dog license tag attached to the dog's collar. Dog owners with multiple dogs must license them individually. A Dog license is valid for one year. If applicant is younger than 18 years of age, a parent or legal guardian shall be named the owner of record and the information must be completed by the parent or legal guardian.

RABIES: Rabies Vaccination certificate must be submitted along with this application according to NYS law. Certificate must be valid for at least 30 days after obtaining a new, renewal or transfer license. (A rabies tag is not sufficient proof.) A dog license will not be issued without a rabies vaccination certificate. If applicable, upload certification below.

SPAY/NEUTER: Applicants who apply for a new or transferred spayed/neutered license must submit proof of spay/neuter from their veterinarian. If applicable, upload certification below.

Brookhaven dog licensing fee schedule calculations are based on the following:

Spayed / Neutered (New, Renewal, Transfer) $7.00 Each
Not Spayed / Not Neutered - Intact (New, Renewal, Transfer) $15.50 Each
Replacement Dog Tag (A new license number will be issued) $5.00 Each

Please contact our Town Clerk's Office for more information at 631-451-9101.

LICENSE TYPE

License Type*

License Number

Transfer Statement (if license transfer selected)

DOG INFORMATION

Name of Dog*

Spayed / Neutered*

Proof of Spayed/Neutered (if applicable)

Microchip Number

Microchip Make

Birth*

Breed*

Sex*

Special Markings

Dominant Color*

Secondary Color

Total Dogs in House*

Was the Dog Ever Declared Dangerous or Vicious?*

Expiration Date (month and year) of Rabies Vaccination (if vaccinated)

Veterinarian Used for Rabies Vaccination (if applicable)

Rabies Vaccination Certificate (if applicable)*

OWNER INFORMATION

New York State Agriculture and Markets law allows only one individual to be the owner. Applications listing more than one owner will not be accepted.

First Name*

Last Name*

Address*

City*

State*

Zip*

Check this Box If You Have a Different Mailing Address

Mailing Address

Mailing Address City

Mailing Address State

Mailing Address Zip Code

Check This Box If Your Dog is Harbored at a Different Address?

Address Where Dog is Harbored

City Where Dog is Harbored

State Where Dog is Harbored

Zip Code Where Dog is Harbored

Primary Phone Number*

###-###-####

Secondary Phone Number

###-###-####

Email Address*

A receipt for this transaction and Town correspondence will be sent to this email address

I hereby acknowledge that I must notify the Town Clerk’s office in writing of changes to my contact information, including my phone number, address, email*

By entering my full name in the box below, I attest, under penalty of perjury, that the information provided on the within Application for a Dog License is true. I further acknowledge that my electronic signature is the legally binding equivalent to my handwritten signature.*

please enter your full name

PAYMENT INFORMATION

I attest that I have read and approve the Town of Online Payment Terms and Conditions*

Yes

Subtotal:

Credit Card Convenience Fee:

Total Cost:

Prove You Are a Human*

Subtotal

Credit Card Convenience Fee

Total Cost

Date and Time

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