IMPOUND

Impounding Officer

Pen Number

Animal impounded
Date available

Impound reason

Location seized

Publish on the Internet

Available for rehome

ANIMAL INFORMATION

Animal

Breed

Colour

Age

Gender

Desexed

Registration tag

Microchip No

Collar / Distinguishing Marks

Animal Photo

OWNER/RELEASE INFO

OWNER INFORMATION

Owner Details

Address

Phone

Date Contacted

Notes / Number of Impounds

RELEASE INFORMATION

Does the animal have a current investigation ongoing?

Contact Officer

Investigation type

CP Number

Approved for Release

HOLD PENDING INVESTIGATION
Release Approved by

Releasing Officer

Date

Lost and found checked

Animal rescue claim checked

Release Reason

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.
Collectors Signature

Euthanised

Form

FORM

Animal Number

Impound Fee $114.50

Registration Fee

Sustenance Fee

Amount

TOTAL FEES PAYABLE

Officer Name

Officer Signature
Date

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.

Wandering At Large Penalty

Office Use Only

Received By

Date

Existing Registration

New Registration

Fees above are taken from Council's Fees & Charges and penalties set by Council Local Laws.
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.