IMPOUND FORM - Fraser Coast

• Document No.

• Audit Title

• Conducted on

  Date

• Impounding Officer

  Select Dan John Sheldon Scott Refuge - Denise Refuge - Marie

  • Dan
  • John
  • Sheldon
  • Scott
  • Refuge - Denise
  • Refuge - Marie

• Pen Number

• Animal impounded

  Date

• Date available

  Date

• Impound reason

  Wandering at large

  Relinquished

  Dog attack

  Hold

  Abandoned
• Location seized
  Address

• Publish on the Internet

• Available for rehome

  YES

  Conditions to be met

  Owner only

  HOLD

ANIMAL INFORMATION

• Animal

  Dog

  Cat

  Other

• Breed

• Colour

• Age

• Gender

  Male

  Female

  Unsure

• Desexed

  YES

  NO

  UNSURE

• Registration tag

• Microchip No

• Collar / Distinguishing Marks

• Animal Photo

  Media

OWNER INFORMATION

• Owner Details

• Date Contacted

  Date

• Notes / Number of Impounds

RELEASE INFORMATION

• Does the animal have a current investigation ongoing?

• Contact Officer

• Investigation type

  Select Dog Attack Aggressive Behaviour Police investigation Ownership dispute Other (see contact officer) RSPCA

  • Dog Attack
  • Aggressive Behaviour
  • Police investigation
  • Ownership dispute
  • Other (see contact officer)
  • RSPCA

• CP Number

• Approved for Release

HOLD PENDING INVESTIGATION

• Release Approved by

  Sign

• Releasing Officer

• Date

  Date

• Lost and found checked

• Animal rescue claim checked

• Release Reason

  Select Owner Pet Warriors Fraser Coast Cat Rescue Wide Bay Animal Refuge Maryborough Refuge Euthanised

  • Owner
  • Pet Warriors
  • Fraser Coast Cat Rescue
  • Wide Bay Animal Refuge
  • Maryborough Refuge
  • Euthanised

• 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

  Sign

FORM

• Animal Number

• Registration Fee

  Select Whole dog or cat - $111.00 Desexed dog - $54.00 Desexed cat - $49.00 Whole dog or cat (8 years+) - $78.00 Pup 3-7months - $54.00 Registered Working Dog - $0.00

  • Whole dog or cat - $111.00
  • Desexed dog - $54.00
  • Desexed cat - $49.00
  • Whole dog or cat (8 years+) - $78.00
  • Pup 3-7months - $54.00
  • Registered Working Dog - $0.00

• Impound Fee

  $0.00

  $108.00

• Sustenance Fee

  Yes

  No

  N/A

• Amount

• TOTAL FEES PAYABLE

• Officer Name

• Officer Signature

  Sign

• Date

  Date

• A wandering at large penalty of $220.00 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

  YES

  NO

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.