Information
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Document No.
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Audit Title
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Conducted on
IMPOUND
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Impounding Officer
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Pen Number
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Animal impounded
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Date available
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Impound reason
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Location seized
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Publish on the Internet
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Available for rehome
ANIMAL INFORMATION
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Animal
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Breed
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Colour
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Age
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Gender
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Desexed
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Registration tag
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Microchip No
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Collar / Distinguishing Marks
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Animal Photo
OWNER/RELEASE INFO
OWNER INFORMATION
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Owner Details
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Address
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Phone
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Date Contacted
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Notes / Number of Impounds
RELEASE INFORMATION
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Does the animal have a current investigation ongoing?
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Contact Officer
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Investigation type
- Dog Attack
- Aggressive Behaviour
- Police investigation
- Ownership dispute
- Other (see contact officer)
- RSPCA
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CP Number
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Approved for Release
HOLD PENDING INVESTIGATION
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Release Approved by
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Releasing Officer
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Date
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Lost and found checked
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Animal rescue claim checked
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Release Reason
- Owner
- Pet Warriors
- Fraser Coast Cat Rescue
- Wide Bay Animal Refuge
- Maryborough Refuge
- Euthanised
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Receipt / Infringement number
I acknowledge as the owner/keeper of this animal I am liable for all claims, losses, expenses, injuries or damages during the period of time which the above described animal was not in your custody or under effective control.
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Collectors Signature
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Euthanised
Form
FORM
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Animal Number
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Impound Fee $114.50
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Registration Fee
- Whole dog or cat - $118.00
- Desexed dog - $57.00
- Desexed cat - $52.00
- Whole dog or cat (8 years+) - $83.00
- Pup 3-7months - $57.00
- Registered Working Dog - $0.00
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Sustenance Fee
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Amount
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TOTAL FEES PAYABLE
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Officer Name
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Officer Signature
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Date
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A wandering at large penalty of $227.00 also applies if your animal is unregistered or has been impounded previously in the last 12 months. If applicable, this fine will be sent to you via Australia Post.
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Wandering At Large Penalty
Office Use Only
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Received By
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Date
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Existing Registration
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New Registration