Impound Form

  • Document No.

  • Audit Title

Animal and Impound Information

Impound Information

  • Pound Location

  • Impounded by

  • Pen Number

  • Date Impounded

  • Date available

  • Impound Reason

  • Location seized
  • Publish on Facebook


  • Animal Type

  • Breed

  • Colour

  • Age

  • Gender

  • Registration Tag

  • Animal ID Number

  • Microchip (date and initial if not found)

  • Collar/Distinguishing Marks

  • Temperament

  • Notes (e.g. condition of the animal)

  • Lost and Found Check

  • Animal photo

Owner and Vet Information


  • Name

  • Phone Number

  • Address
  • Number of Impounds/warnings

  • Date Contacted

  • Date Letter Sent to Owner

  • Notes

Vet Information

  • Vet Treatment?

  • Notes

  • Name of Surgery

  • Vet Name

  • Treatment

  • Vet Signature

Release Information and Fees/Charges


  • Released by

  • Released to Name

  • Released to contact details

  • Photo ID Sighted (date and initial)

  • Date Released

  • Desexing Compliance Notice

  • Desexing Prepaid Voucher (attached)

  • 2nd Microchip Scan (date and initial)

  • Remove from Facebook

  • Release Reason

  • Infringement number


  • Registration Fee ($)

  • Impound Fee ($)

  • Sustenance Fee ($)

  • Vet fees ($)

  • Total Fees Payable

  • Receipt/Infringement Number

  • Signature

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