Breed
Color(s)
Markings
Name
Male
$10.00
$18.00
$ 0.00
1 YR
Female
Year of Birth
Microchip
Maker
Microchip
Number
LICENSE FEES
Spayed/Neutered
Unspayed/Unneutered
Exempt Dogs: War, Police, Detection,
Therapy, Working Search, Hearing and
Service Dogs (Proof is required)
PHOTO OPTION
2 YR Licenses can only be issued if the rabies vaccination expiration exceeds the license
period.
Example: If you are licensing your dog in January 2018, in order to obtain a 2 YR
License, the rabies vaccine expiration must be on/after January 31, 2020. If it isn’t, then
you must apply for a 1 YR license.
$30.00
$17.00
2 YR
2 YR licenses
unavailable for
exempt dogs
*
*
I do not want this option
Photo is enclosed
Photo will be emailed
If you opt for a photo of your dog to be placed on the license, you can either enclose a photo or send us a digital
image at the following address: Please be sure that you include the name and doglic@whiteplainsny.gov
address that is on the application and send it the day the application is mailed. Photos may be cropped to
maximize benefit. Any photo enclosed by mail will be returned. If you choose to add a photo, please add a one-
time fee of $2.00 to your total.
First
Middle
Street
Name
Apt.
No.
Zip
Code
House
Number
Last
NAME
ADDRESS
PHONE
SIGNATURE
EMAIL
DATE
Please sign before mailing
PET INFORMATION
CHECKLIST
OWNER INFORMATION
INSTRUCTIONS
1
2
ORIGINAL
RENEWAL
LICENSE NO.
ISSUED
Manufacturer
Serial Number
Veterinarian
Date
Vaccinated
1 YR
3 YR
Duration
EXPIRES
TRANSFER OF
OWNERSHIP
RABIES VACCINE INFORMATION
Please complete sections 1 & 2, and sign the application before mailing/bringing it in.
Your telephone number and email address will be used for the sole purpose in
communicating with you about your dog. The telephone number you provide should
be the contact number you prefer in the event your dog is found.
Each application must be accompanied by a current rabies certificate and proof of
Spay/Neuter, if applicable. If the Rabies Vaccination Certificate indicates that your
dog is altered, we will accept that in lieu of the Spay/Neuter Certificate.
Payment can be in the form of a personal check or money order by mail (made
payable to the “City of White Plains), and cash or credit card in person.
Please call our office with any questions by dialing (914) 422-1227.
DOG LICENSE APPLICATION
City Clerk 255 Main Street, Rm. 100 White Plains, NY 10601
(914) 422-1227 email: doglic@whiteplainsny.gov
LICENSE INFORMATION
F
O
R
O
F
F
I
C
I
A
L
U
S
E
O
N
L
Y
Completed Application
Rabies Vaccination Certificate Payment
Spay/Neuter Certificate (if applicable)
Photo (if applicable)
WHITE PLAINS RESIDENTS
Sex
