IMPOUND FORM - Maryborough

• Document No.

• Audit Title

• Conducted on

  Date

• Impounding Officer

  Steve A

  Steve N

  Shayne

  Dave

  MB Refuge

• 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

  Male

  Female

  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