FCRC Impound Form - Fraser Coast Regional Council 9.0

• Document No.

• Audit Title

Impound Information

• Pound Location

  Hervey Bay

  Maryborough

• Impounded by

• Pen Number

• Date Impounded

  Date

• Date available

  Date

• Impound Reason

  Select Wandering at Large Relinquished On Hold Investigation Seized Abandoned

  • Wandering at Large
  • Relinquished
  • On Hold
  • Investigation
  • Seized
  • Abandoned
• Location seized
  Address

• Publish on Facebook

  YES

  No (Owner must be known)

ANIMAL INFORMATION

• Animal Type

  Cat

  Cow

  Dog

  Horse

  Other

• Breed

• Colour

• Age

• Gender

  Select ENTIRE MALE DESEXED MALE ENTIRE FEMALE DESEXED FEMALE UNKNOWN DESEXED UNKNOWN

  • ENTIRE MALE
  • DESEXED MALE
  • ENTIRE FEMALE
  • DESEXED FEMALE
  • UNKNOWN
  • DESEXED UNKNOWN

• 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

  Media

OWNER INFORMATION

• Name

• Phone Number

• Address
  Address

• Number of Impounds/warnings

• Date Contacted

  Date

• Date Letter Sent to Owner

  Date

• Notes

Vet Information

• Vet Treatment?

  Yes

  No

• Notes

• Name of Surgery

• Vet Name

• Treatment

• Vet Signature

  Sign

RELEASE INFORMATION

• Released by

• Released to Name

• Released to contact details

• Photo ID Sighted (date and initial)

• Date Released

  Date

• Desexing Compliance Notice

• Desexing Prepaid Voucher (attached)

• 2nd Microchip Scan (date and initial)

• Remove from Facebook

  Yes

  No

• Release Reason

• Infringement number

FEES AND CHARGES

• Registration Fee ($)

• Impound Fee ($)

• Sustenance Fee ($)

• Vet fees ($)

• Total Fees Payable

• Receipt/Infringement Number

• Signature

  Sign