Neutered Dog Declaration
If during the year your dog has been Neutered/speyed and you notify us you may be
eligible to a pro rata refund of your part of your registration fee (from date of notification).
Please complete this form and forward to Masterton District Council, Animal Services, P O
Box 444, Masterton 5840 or email: email@example.com
VETERINARY CLINIC Please provide written confirmation from the vet if they have neutered/speyed your dog – this
can be emailed by the vet clinic to firstname.lastname@example.org Or they can complete the section below
Name of Veterinary Clinic:
On behalf of the above named Veterinary Practice I confirm that the dog/s listed above were desexed
by a member of our Veterinary practice:
(Vet Clinic Staff member) with Clinic Stamp
I hereby certify that I am the registered dog owner and the above information it true and correct.
(Please note we can impose a penalty for providing a false statement under the Dog Control Act 1996)
Signature of registered owner
Credit Dog Account
Credit Rates Account
Property Valuation Number:
Credit Bank Account Number
Please provide a bank deposit slip or printout from your bank. Hand written
account numbers must be written by owners and are provided at owner’s risk.