Working Dog Declaration
Form
Please return this form to: info@adc.govt.nz or Ashburton District Council, PO Box 94, Ashburton 7740
Applicant Details
I_______________________________________________________(full name) hereby declare that my dog
__________________________________ (dog name and breed) is a working dog as defined under Section
2(b)(ii) of the Dog Control Act 1996.
Signature and Date
I am prepared to demonstrate my dog’s abilities to comply with Section 2(b)(ii) of the Dog Control Act
1996 should Council request such a demonstration.
Signed: _____________________________ Date: _________________________________
Note: Section 2(b)(ii) of the Dog Control Act 1996 states a working dog is any dog kept solely or principally for the
purpose of herding or driving stock. Making a false declaration renders the dog owner to an infringement notice of
$750 being issued to them under Section 41 of the Dog Control Act 1996.
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome