DOG’S DETAILS
PREVIOUS DOG OWNER DETAILS
DECLARATIONS
NEW OWNER’S DETAILS
Name of dog: Current tag number:
Animal ID: Microchip number:
Breed of dog: Colour of dog:
Full Name:
Address:
Contact Phone number:
Please tick the following: Given the dog away Sold the dog Other
I, declare that my dog
has now changed ownership to
I, declare that I am now the owner of
Signature: (previous owner) Date:
Signature: (new owner) Date:
Section 48 of the Dog Control Act 1996
Under Section 48 of the Dog Control Act 1996, you are required to inform the council within 14 days in writing of any change of ownership as
dened under the Act. Failure to comply with the requirements of Section 48(1) of the Dog Control Act 1996 may result in legal action.
Full Name: D.O.B:
Address:
Phone: Mobile:
Email:
NOTE: your date of birth is required to enable you to be distinguished from other persons with the same name.
Certainty of identication is required in the enforcement of the provisions of the Dog Control Act 1996.
*Please note that all elds on this form are mandatory to change the ownership of any dog*
CHANGE OF OWNERSHIP AGREEMENT
Page 1/1 // February 2016
Queenstown Lakes District Council
Private Bag 50072, Queenstown 9348
Gorge Road, Queenstown 9300
P: 03 441 0499
E: services@qldc.govt.nz
www.qldc.govt.nz
AGREEMENT TO
CHANGE OWNERSHIP
OF DOG
click to sign
signature
click to edit
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click to sign
signature
click to edit
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