new dog/cat registration · pdf filenew dog/cat registration form council offices ... gender...
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NEW DOG/CAT REGISTRATION FORM
COUNCIL OFFICES 41 High Street, PO Box 21
Wedderburn Vic. 3518
CONTACT NUMBERS Ph 03 5494 1200 Fax 03 5494 3003
CASHIER’S HOURS 8.15 am to 4.45 pm Monday to Friday
ABN 90 925 450 534
LIFETIME TAGS IN USE OWNER’S DETAILS
Title: ________________ First Name: ______________________ Surname: _____________________________________
Street: ________________________________________ Town: ______________________________ Postcode: ________
Phone No. (Home): ___________________________ (Work): ______________________ (Mobile): ___________________
Email: _____________________________________________
Pension No (if applicable*): _____________________________ *Please note Health Care Card is not acceptable
ADDRESS WHERE ANIMAL IS KEPT (if different from above)
Street: ________________________________________ Town: ______________________________ Postcode: ________
ANIMAL DETAILS (S) Animal 1 Animal 2 Animal 3 Animal 4 Animal Type Dog Cat Dog Cat Dog Cat Dog Cat
Animal Name
Breed
Microchip No. *Please affix microchip sticker in space provided
Colour / Markings
Age
Desexed Yes No Yes No Yes No Yes No
Gender Male Female Male Female Male Female Male Female
Fee (see note 1)
Council Tag No. (Office Use)
Note 1: Please review Council’s Fees and Charges as published on our web site, for assistance please contact our office.
Owner of the animal must produce documentations to support claim for reduced fee status of animal. Please read reverse of registration form for payment and restricted breed declaration • All cats and dogs must be registered by law, immediately they turn three months of age. • Owners of a dog or cat who fail to register their animal are liable to a fine of not more than 10 penalty units • After 1 May 2007, Council must not register a dog or cat that has not been implanted with a microchip, including
previously registered dogs and cats that move into Loddon from another area. This does not include animals that have already been registered in Loddon Shire prior to this date.
• A permit is required pursuant to Local Law No 4 to keep more than two dogs and/or two cats in a residential or rural residential area.
• This registration period expires on 9th April each year
NEW DOG/CAT REGISTRATION FORM
COUNCIL OFFICES 41 High Street, PO Box 21
Wedderburn Vic. 3518
CONTACT NUMBERS Ph 03 5494 1200 Fax 03 5494 3003
CASHIER’S HOURS 8.15 am to 4.45 pm Monday to Friday
ABN 90 925 450 534
RESTRICTED BREED DOGS – IMPORTANT NOTICE The State Government has made significant amendments to the Domestic Animals Act 1994 in relation to the keeping of “Restricted Breed Dogs”. A “Restricted Breed Dog” means a dog of a breed whose importation into Australia is prohibited under the Commonwealth “Customs (Prohibited Imports) Regulations 196. These breeds currently are: • PIT BULL TERRIER OR PIT BULL TERRIER CROSS • DOGO ARGENTINO • FILA BRASILEIRO • JAPANESE TOSA • PERRO DE PRESA CANARIO OR PRESA CANARIO
DECLARATION
I, of (address)
declare that I am the owner of a “Restricted Breed Dog” being a:
declare that I am NOT the owner of a “Restricted Breed Dog” And I make this statement conscientiously believing the same to be true and by virtue of the provision of Section 10(3) of the Domestic Animals Act 1994, understand that a person who in any application for registration fails to complete this declaration shall be guilty of an offence and liable to a penalty not exceeding 10 penalty units
APPLICANT’S SIGNATURE
Signature: _________________________________________________________ Date: ___________________________
*Parent or guardian to sign if owner is under 18 years of age. Office Use
Receipt Number: ___________________
Date: __________________________
Privacy statement Personal information collected by Council is held securely and used solely for municipal purposes as specified in the Local Government Act 1989. Council may disclose this information to other organisations if required or permitted by legislation. Should you wish to access or modify this information, please contact Council on (03) 5494 1200 or email [email protected]
Loddon Shire Council 41 High Street, Wedderburn, Victoria PO Box 21, Wedderburn, Vic 3518 Telephone: (03) 5494 1200 Facsimile: (03) 5494 3003 Email: [email protected] Web: www.loddon.vic.gov.au
PAYMENT OPTIONS
☐ Cash Payments can be made in our Wedderburn office (please do not send cash in the mail)
☐ I have enclosed a cheque/money order to the value of $
☐ Please charge my credit card for the amount of $
Card Type ☐ MasterCard ☐ Visa Card CCV Expiry Date:
Card Number
Name on Card Signature