Fillable DOG REGISTRATION FEE DECLARATION FOR A REFUND APPLICATION (Queenstown Lakes District Council New Zealand)

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DOG REGISTRATION FEE DECLARATION FOR A REFUND APPLICATION (Queenstown Lakes District Council New Zealand)

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The DOG REGISTRATION FEE DECLARATION FOR A REFUND APPLICATION (Queenstown Lakes District Council New Zealand) form is 1 page long and contains:

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Country of origin: NEW-ZEALAND
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DECLARATION FOR A REFUND
YOUR BANK DETAILS
I [name] of [address]
hereby make an application for a refund of part of the dog control fee paid for the registration of my dog.
Email: Phone:
Dogs Name:
Tag Number: Animal ID Number:
The cause of death being:
Date of Death:
Signature**: Date:
Account Name:
Account Number:
NOTE: ALL APPLICANTS
Under the Dog Control Act 1996, a refund on the death of a dog is on a pro rata basis and is calculated at the rate of 1/12 for
each complete month remaining in the registration year after the date of application for the refund.
Neutered: Yes No
Amount Due: $
Month Deceased:
Approved: Date:
FOR OFFICE USE ONLY
Direct Credit
Please enclose a Veterinary
Certicate (where available)
**If this form is being completed on-line you will not be able, or required, to sign this form and
the on-line lodgement will be treated as conrmation of your acknowledgement and acceptance
of the above responsibilities and liabilities and that you have made the above representations,
warranties and certication.
Page 1/1 // July 2017
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
APPLICATION FOR REFUND OF
DOG REGISTRATION FEE
FOLLOWING DEATH
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DOG REGISTRATION FEE DECLARATION FOR A REFUND APPLICATION (Queenstown Lakes District Council New Zealand)

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Completed 20 January 2021

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