Name:
Postal Address:
Daytime Phone: Cell:
Email: Dog Registration #
Infringement Notice # Date Issued:
Dogs name, breed and description:
Address dog resides at:
Explanation:
29 Bowler Avenue, Gore 9710
PO Box 8, Gore 9740
Phone 03 209 0330
Email info@goredc.govt.nz
www.goredc.govt.nz
Dog Infringement Offence
Explanation Form
Dog Infringement Offence - Explanation Form 1
continue overleaf if required
Explanation continued:
Signature Date:
Once you have completed this form, you can email it to info@goredc.govt.nz or post to Gore District
Council, PO Box 8, Gore.
Please retain your dog infringement notice. You will be advised of the decision in due course.
Would you prefer to be contacted by: post email
Dog Infringement Offence - Explanation Form 2
click to sign
signature
click to edit
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