TAX INVOICE WHEN PAID

Full Name APPLICATION To REGISTER DOG(s)

GST Reg N0: 51-994-353 For period I July 2016 to 30 June 2017
Postal Address

Please return this form ith payment!

If you do not return this form
your dog/s will riot be registered

Dogls Location
Contact Phone
DUE DATE I July 20.6 NOTE PAYMENT REQUIRED PRIOR To I August 20.6. Owner's date of birth
PAYMENT AFTER , AUGUST INCURS A 50% PENALTY.
^^
PLEASE READ OWNER INFORMATION OVERLEAF PRIOR To COMPLETING FORM

If any details have changed, please make amendments to this form. Completed forms may be emailed to dogz@cluthadc. govt. nz
Dog Ref icrochip Name of Dog Colour(s) Breed Age Sex Class Fee Tag No.
YIM F1M

Please register my dog(s) for the yearending 30/6/2017. I confirm that the above information relating to the dog(s) in my care
is correct and I do riot own or have in my possession any other dog(s) over the age of 3 months
If paying by internet banking please
Cash . Cheque . Eftpos . ensure your name and reference
Signature Date
Online payment . Date paid number are shown as particulars
APPL, CAT, ON ,"VAL, D ,F NOT S, GNED Bank A1c No. 03,734 006,851 02 Please tick if GST receipt required .

Please Do NOT se arate - retu n both portions Registration period from 7 July 2076 to 30 June 2077

Full Name Dog's name Tag No.

Postal Address

^^ Tax Invoice When Paid

GST N0: 51-994-353

PO Box 25, Balclutha 9240

I Rosebank Terrace, Balclutha
 ADVICE OF DOGS SOLD OR DISPOSED OF DURING YEAR

Dog's Name Dead ( ) Sold to Address

ALL DOGS ' usT BE REGISTERED HE THEY ATTAI THE AGE OF 3 ONTHS CHANGE OF O ERSHIP
The owner of a dog must keep the dog under control at all times and, when in a public place with the Where the ownership of a registered dog is changed both the previous owner and the new owner
dog, must use or carry a leash at all times must each give written notice within 14 days to the Territorial Authority or Authorities concerned of the
change of ownership and the residential address and the address at which the dog will ordinarily be
The owner of any dog must kept
. ensure that the dog receives proper care and attention and is supplied with proper and
sufficient food, water, and shelter; and If the fee for the registration of a dog is paid and that dog dies, a refund will be made on request as
. ensure that the dog receives adequate exercise follows

The owner of a dog must ensure, when the dog is on land or premises occupied by the owner where a dog dies before the commencement of the year, the full fee will be refunded
. that the dog is under the direct control of a person; or where the dog dies during the year, 1/12th of the annual fee for each complete month
. that the dog is confined within the land or premises in such a way that it cannot freely remaining in the registration year after the date of application for a refund will be refunded
leave the land or premises

Replacement discs may be obtained from the Clutha District Council If the current disc has been lost
or stolen