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2. Payment

   Payment is due once form is submitted. Pay online, in person or mail check to:

   Town Clerk

   4 South Eagleville Road

   Mansfield, CT 06268

4. First & Last Name of Owner*
5. Email Address*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Mailing Address

    If different than address above

15. City
16. State
17. Zip Code
19. Phone Number*
21. Second Phone Number

    Providing two phone numbers helps us contact families when a lost dog is found.

23. Dog Name*
25. Dog Breed*
    If mixed, please provide best guess.
27. Dog Age*

    Please specify years or months (e.g. 2 years or 7 months)

28. Dog Coloring*

    Please describe the dog's coloring. You may list more than one color.

29. Dog Sex*

    1. Female
    2. Male
31. Spay/Neuter *

    1. Spayed
    2. Neutered
    3. Unaltered
32. Spay/Neuter Documentation

    Please attach a copy of the dog's spay/neuter certificate, if applicable. Photos of hard copy certificates or documents are acceptable.

34. Spay/Neuter Documentation Submission Type*

    1. ATTACHED - I attached the spay/neuter documentation.
    2. MAIL - I mailed the spay/neuter documentation. I understand that if I want to qualify for the altered dog license fee, the Town Clerk must receive my documentation.
    3. EMAIL - I emailed the spay/neuter documentation. I understand that if I want to qualify for the altered dog license fee, the Town Clerk must receive my documentation.
    4. IN PERSON - I will bring the spay/neuter documentation to the Town Clerk's Office. I understand that if I want to qualify for the altered dog license fee, the Town Clerk must receive my documentation.
    5. N/A - My dog is not spayed or neutered.
36. Rabies Vaccine Requirement

    A dog license can not be issued in the State of Connecticut until the Town Clerk has received documentation of valid rabies vaccination.

37. Rabies Vaccination Documentation

    Please attach a copy of the dog's rabies vaccination certificate.  The rabies vaccine must be 1) current at the time of licensure AND 2) not expire before 7.01.2024. 

39. Rabies Documentation Submission Type*

    1. ATTACHED - I attached the rabies vaccine documentation.
    2. MAIL - I mailed the rabies vaccine documentation to the Town Clerk. I understand that I will not receive a license until the Town Clerk has received proof of rabies vaccine and payment.
    3. EMAIL - I emailed the rabies vaccine documentation to dogs@mansfieldct.org. I understand that I will not receive a license until the Town Clerk has received proof of rabies vaccine and payment.
    4. IN PERSON - I will bring the rabies vaccine documentation to the Town Clerk's Office. I understand that I will not receive a license until the Town Clerk has received proof of rabies vaccine and payment.
    5. None of the above
41. Explanation*

    Please explain if you selected None of the Above.

43. Payment

    Payment is due once form is submitted. Pay online, in person or mail check to:

    Town Clerk

    4 South Eagleville Road

    Mansfield, CT 06268

Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field