Replacement dog tag
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
Receipt NAR
Replacement tag number(s)
1. 2. 3.
Tag issued by
Computer records updated: Yes No
Date
/ /
Initials
Owner details (Please print in CAPITALS)
Name of owner
Address
0
- / /
Phone number Owner’s date of birth
Dog details
Dog name Breed Colour Sex Age Tag No. Dog ID
1.
2.
3.
Describe what happened to the old tag.
Note: Attach old tag(s) if possible.
Signature
I certify that the above particulars are true and correct.
Fee: $2.00
/ /
2 0
Signature of applicant Date
click to sign
signature
click to edit
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