If during the year, you move addresses, or make changes affecting the details held
on the Council’s Dog Register you are required by law to advise the authority.
Please complete this form and send to: Masterton District Council, Animal Services, PO Box 444, Masterton 5840 or email
to: animalservices@mstn.govt.nz
Name Breed Age Sex Tag ID
Please add extra dogs on the back of this form
OWNER DETAILS (Recorded in our system) NEW DETAILS (Only fill in boxes to be updated)
Owner’s name Physical address
MDC Owner No.
(may be obtained from your dog registration invoice)
Postal address
(if different from above)
Date of birth
(if different from address)
Physical address
Postal address (if different from above) Work telephone number
Work telephone number
Home telephone number
Home telephone number Mobile phone number
Mobile phone number Email
Email Microchip
I hereby declare that the details shown above are true and these changes took place on or about / /
Signature of registered owner Date
That it is an offence when making an application for the registration of a dog to make any written statement
knowing that statement to be false. On conviction a court may impose a fine not exceeding
The Dog Control Act 1996 requires Council to record the dog owner’s date of birth
Animal Services, P O Box 444, Masterton 5840, 06 370 6300, animalservices@mstn.govt.nz, www.mstn.govt.nz