Dog transfer
Please read this first
This form will be scanned by electronic equipment. It is important that you:
use a blue or black pen to mark your answers; and
print clearly.
tararua district council
26 gordon street
po box 115
dannevirke 4942
06 374 4080
info@tararuadc.govt.nz
Office use only
Records updated: Yes No Outside TA notied: Yes No
Date
/ /
Signature
Current owner details (Please print in CAPITALS)
Name of current owner
Current owner’s date of birth
/ /
NAR
Address
New owner details (Please print in CAPITALS)
Name of new owner
Phone
0
-
Date of birth
/ /
NAR
Address
Dog details
Dog name Breed Colour Sex Age Tag No. Dog ID
1.
2.
3.
4.
5.
Dog(s) have transferred:
to an existing dog owner (within Tararua) to a new owner (within Tararua) out of district
Signature
I declare that all the above details are correct and understand that giving false particulars and information is an offence under the
Dog Control Act 1996 and is subject to an infringement fee of $750.00.
/ /
2 0
Signature Date
Witness signature (ofce staff)
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
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