Form Center

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 7.01.2023. 

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