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2. First Name*
3. Last Name*
5. Address*
7. City
8. State
9. Zip Code
11. Email*
12. Phone*
14. Property Owner (if Different Than Applicant)
16. First Name
17. Last Name
19. Name of Dog*
20. Breed of Dog*
22. Age of Dog*
23. Gender*

    1. Female Spayed
    2. Female Not Spayed
    3. Male Neutered
    4. Male Not Neutered
25. Primary and Secondary Dog Color*
26. Rabies Tag Number*
28. Date of Vaccination and Expiration*
29. Name of Veterinarian*
31. Veterinarian's Address*
33. City
34. State
35. Zip Code
37. Veterinarian's Phone Number*
39. Microchip*

    1. Yes
    2. No

41. The licensing fee is $20 for each spayed or neutered dog and $25 for each dog that is not spayed or neutered. Your application for a dog license will be complete following submission of this form, a current rabies certificate and payment of the appropriate fee to the Town of Danvers. Once your application is processed, a electronic payment link will be sent to you. Payment can be mailed to "Dog Licensing, Danvers Town Hall, 1 Sylvan Street, Danvers, MA 01923" or delivered to Town Hall.

43. Upload Rabies Certificate (or delivery copy with payment)
45. 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.
47. Electronic Signature
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field