Dog Registration Form 07

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					                Council Offices:                                        Dog Control Act 2000, Section 9 (2)(a)
                19 Alexander Street
                BOTHWELL TAS 7030
                Ph: (03) 6259 5503
                                                              Application for the Registration of
                Fax: (03) 6259 5722                            a Dog for the year commencing
                6 Tarleton Street
                HAMILTON TAS 7140                                       1st July 2007
                Ph: (03) 6286 3202
                Fax: (03) 6286 3334
                                                                                                 Office Use Only
                                                                                                  Dog Number ….….......

                                                                                                  Property Number ……..

                                                                                                  Tariff ……….…………

                                                                                                  Tag Number …...……..

                                                                                                  New Tag Number ……
Instructions For Registering A NEW Dog                                                            Receipt Number …….
Please complete the form below, sign the declaration and lodge this form at the
Council Office. This year’s registration fee will then be determined by the Cashier.
IMPORTANT: For a tariff other than “Domestic dog (not desexed)”, evidence must be
                                                                                              Registration Fee:
supplied to accommodate the new tariff.
Instructions For Re-Registering A Dog                                                                   Registration Fees
The form below has been filled in with the details supplied when the dog was regis-         Tarriff                       Paid By    Paid After
tered last year. Should there be any changes, whether these be to either the dog                                         31st July   31st July
owner’s details or the dog’s details itself, please make the changes on the form.   Domestic dog (desexed)                $10.00       $20.00
Payment and Lodgement                                                                        Domestic dog (not de-        $30.00       $50.00
When satisfied that all details are correct, sign the declaration at the bottom of the       sexed)
form. Payments and Lodgement can be made personally at the Central Highlands                 Pensioner                     $5.00       $10.00
Council Offices between the hours of 8:30am and 5:00pm Monday to Friday. Or by               (1st Dog Only)
mail - cheques and Money Orders to be made payable to the “CENTRAL HIGH-                     Working dog which is          $5.00       $20.00
LANDS COUNCIL”. Or complete the Credit Card Payment Option: (BLOCK LETTERS)                  kept for the purpose of
                                                                                             working farm stock
Card Holder’s Name: _________________________ Signature: _____________________
                                                                                             Greyhound                     $5.00       $20.00
Credit Card Number:                                                   Expiry Date:
                                                                                             (TGRA registered)
                      Bankcard       Visa        Mastercard                                  Registered Breeding Dog       $5.00       $20.00
                                                                                             (TCA registered and dog
                                                                                             owner holding current
  Owners Name:                                                                               membership of the TCA)
                                                                                             Special Assistance Dog         Nil          Nil
                                                                                             (Guide Dog/Hearing
  Owners Address:                                                                            Dog)
                                                                                             Declared Dangerous Dog       $250.00

                                                              Phone                            The Re-Registration of a dog must be un-
                                                                No:                             dertaken before 31st July or a penalty
                                                                                                       charge will be applied.

  Breed:                                                                                     Pensioner Rate: - The pensioner rate applies to
                                                                                             one dog only, (owned by a pensioner), and as
                                                                                             such, the Pensioner Concession Card MUST be
  Colour:                                                                                    produced when payment is made.
                                                                                             Desexed Dogs:- Owners who wish to claim an
              Date of Birth (month/year):                                                    initial deduction on Registration Fees for desexed
                                                                                             (spayed or neutered) dogs must produce a veteri-
                                                                                             narian certificate as proof or sign an appropriate
  Sex         Male        Female      Is the Dog Desexed:             Yes            No      Statutory Declaration.

  Dogs Name:                                                                                 Change Of Circumstances:- Please notify Coun-
                                                                                             cil in the event of the death or change of owner-
                                                                                             ship of the dog.
  Dog Resides At:
                                                                                                     This Form Must
                                                                                                   Accompany Payment.

     Declaration: I declare the above information to be true in every respect to the best of my knowledge and belief.

                      Signature:                                                     Date:

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Description: Dog Registration Form 07