OWNER DETAILSTitle

Name owner goes by

Postal Address

Owner’s Name (if under the age of 18 years)

Address where animal(s) is/are kept, if different from above

Contact Nos

Sex: M / F Date of Birth / /

Suburb Postcode

First Name Middle Name Surname

Home Work Mobile

Email Address Yes NoWould you like to receive your renewal notice by email?

Pension Number

Second Contact Name Phone Number

ANIMAL DETAILSAnimal 1 Animal 2 Animal 3 Animal 4

Animal Type (tick one box)

Animal’s Name

Date of Birth of Animal

Breed

Colour

Gender (tick one box)

Desexed

Microchip Number

Restricted Breed (tick one box)

Yes No Yes No Yes No Yes No

Council must not register a dog or cat that has not been implanted with a microchip; this includes dogs and cats that move into Mitchell from another Council.

Male Female Male Female Male Female Male Female

Yes No Yes No Yes No Yes No

Dog Cat Dog Cat Dog Cat Dog Cat

I delcare that the dog/s on this application has been correctly identified as to whether it is or not a restricted breed. Restricted breeds are as follows; a Pit Bull Terrier, a Fila Brasilero, Dogo Argentino, Japanese Tosa, Perro de Presa Canario or Presa Canario. Under section 3 (3) of the Domestic Animals Act 1994 a dog that falls within the approved standard for a breed specified above is to be taken to be a dog of that breed.

Signature of owner...................................................................... Date.................................. Print Name.....................................................................

Declared Dangerous Dog (see over)

Declared Menacing Dog (see over)

Fee $

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Lifetime Tag No. (Office Use Only)

I delcare that the information contained in this application regarding my dog/s and/or cat/s is true and correct and I make it on the understanding that a person supplying flase information is liable to prosecution under the Domestic Animals Act 1994.

Signature of owner...................................................................... Date............................

Print Name.................................................................................. OFFICE COPY

(tick one box)Proof of eligibility required

APPLICATION TO REGISTER DOMESTIC ANIMAL(S).For the year ending 10 April 2018Under the provisions of the Domestic Animals Act 1994, every dog and cat three months of age and over must be registered with your local Council. Existing registrations must be renewed by 10 April each year. Before Council can accept a new animal registration, dogs and cats must be microchipped. If an owner is under the age of 18, the parent or guardian of that person is deemed to be the owner.

DECLARATION

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Reference (Office Use Only)

DOGS Regular Pension

CATS Regular Concession

Standard fee (no discounts below apply)

$50

Desexed $30 $15

$25

DOCUMENT CHECK (Please provide a copy of the following documentation)

MANDATORYProof of microchip implant

ADDITIONALProof of desexingApproved obedience training certBreeding licenceMembership to any applicable organisationProof of working dog statusValid pension card

PAYMENT DETAILS

ConcessionFor persons eligible under the State Concessions Act 2004 (Pension card concession card, War Widow entitlements or TPI entitlements), a 50% concession rate applies for both maximum and reduced fees unless specified. This does not include Health Care Card holders. Please present your card to receive this concession. Please note that concession rates are not applicable to declared dogs, ie dangerous, menacing or restricted breed.

Declared DogsIf Council declares a dog to be dangerous or menacing there are certain rules that must be complied with in accordance with the Regulations under the Domestic Animals Act 1994. More information can be found at www.mitchellshire.vic.gov.au

Restricted Dog BreedsSpecific controls under the Domestic Animals Act 1994 have been introduced for the keeping of Restricted Breed Dogs. All Restricted Breed Dogs are required to be desexed and microchipped. Within the ‘Approved Standard’, American Staffordshire Terriers are not considered Restricted Breed Dogs, if the owner has one of the following certificates stating that the dog is an American Staffordshire Terrier -

• A pedigree certficate from: - the Australian National Kennel Council- member body of the Australian National Kennel Council- a national breeed council registered with Australian National Kennel Council

• A certificate signed by a veterinary practitioner

Current owners may keep their restricted breed dogs as long as the dogs were:1. In Victoria prior to 1 September 2010, AND2. Registered (as any breed) with the local council prior to 30 September 2011.

A copy of the standard is available is available at www.delwp.vic.gov.au

State Government LevyA State Government levy of $3.50 for dog registration and $2.00 for cat registration is included in your pet’s registration fee. This levy is primarily used to fund responsible pet ownership educational programs.

Certificate of RegistrationOnce your registration fee is paid, this notice will be deemed to be your certificate of registration.

PenaltiesInfringements may be issued if you are in breach of the Domestic Animals Act 1994. Offences include;• Not registering or renewing your pet’s registration• Your pet not wearing it’s Council registration tag• Your pet found wandering at large or not securely confined to your premisesMore information on offences can be found at www.mitchellshire.vic.gov.au

Permits and Local LawsUnder Council’s Local Law No 1 Community and Environment 2013, a permit is required to keep more than two dogs or two cats per residential property. Numbers depend on your location so talk to the Community Compliance Team for advice. Dog owners must remove dog faeces left by their dog in public places.

Privacy NotificationThe personal information requested on this form is being collected by Council for the enforcement and administration of animal control in accordance with Sections 10 and 18 of the Domestic Animals Act 1994. The personal information will be used by Council and its Contractors for that primary purpose or directly related purposes and may be disclosed as required by law. The applicant may apply to Council for access an/or amendment of the information.

FEE DETAILS

MORE ABOUT DOGS MORE ABOUT REGISTRATION

*Approved obedience training organisationsThere are four organisations whose qualified trainers are issuing certificates that entitle you to a discounted registration fee:1. DOGS Victoria2. Australian Association of Professional Dog Trainers Inc3. The Gentle Dog Trainers Association4. Four Paws K9 Training

Applicable organisationsTo receive a reduced registration rate for their animal, the owner of the animal needs to be a member of one of the applicable organisations with which the animal is registered.1. Australian National Cats Inc2. Cats Victoria Inc3. Dogs Victoria4. Feline Control Council (Victoria) Inc5. Greyhound Racing Victoria6. The Governing Council of the Cat Fancy Australia and Victoria Inc

PAYMENT OPTIONS

In Person

By Mail

Broadford Customer and Library Service Centre113 High Street, Broadford, VIC, 3658Phone (03) 5734 6200Monday to Friday - 8.30am to 5pm

Seymour Customer and Library Service Centre125 Anzac Avenue, Seymour, VIC, 3660Monday, Wednesday and Friday - 10am to 5pmTuesday and Thursday - 10am to 6pmSaturday - 9am to 12noon

Wallan Customer and Library Service CentreWellington Square, Wallan, VIC 3756Monday and Friday - 9am to 6pmTuesday to Thursday - 10am to 6pmSaturday - 9am to 12noon

Kilmore Customer and Library Service Centre12 Sydney Street, Kilmore, VIC, 3764Monday, Tuesday, Wednesday and Friday - 9am to 5pmThursday - 10am to 6pmSaturday - 9am to 12noon

Bring your completed form to one of the Customer and Library Service Centres listed below. Payments by EFTPOS can be made at all centres.

Mitchell Shire Council113 High Street Broadford, VIC, 3658

Send your completed form (including the required documentation) along with a cheque or competed credit card payments details to:

Mastercard Visa CashCheque

Credit Card No:

Expiry date:

Name on card: ___________________________

Signature: ______________________________

Total Paid

$200 $100

KCC/VCA registered, working dog or older than 10 years

$40 $20Obedience trained

Desexed and obedience trained *conditions apply $20 $10

Declared dogs (Dangerous, Menacing and Restricted Breed) no discounts apply $350

N/A

Initial registration for adopted dog from an approved shelter or under 12 weeks of age $5

N/A

Standard fee (no discounts below apply) $200 $100

Desexed $20 $10

$50 $25FCC registered or older than 10 years

Initial registration for adopted cat from an approved shelter or under 12 weeks of age $5

N/A

OTHER INFORMATION Foster Carer Packages now available – contact 5734 6200 for more information

Proof of eligibility is required to qualify for a discounted category