NEW ANIMAL REGISTRATION APPLICATION FORM
All cats and dogs over 3 months of age and being registered for the first time MUST be microchipped. This will include any previously registered cats and dogs that move to the Mornington Peninsula Shire, from another municipality. Council is unable to accept registration unless the animal is microchipped.
This form WILL NOT be processed without proof of microchipping.
The Shire’s General Purposes Local Law 2012 Part 5No 44 (3) require the de-sexing of a CAT over the age of 3 months, unless the Owner has applied for a Permit and the owner of the cat is a member of an Applicable Organisation, with which the cat is registered.
WARNING:If this application will result in more than the prescribed number of cats and dogs shown in the table below being housed at this address, you may require a Local Law Permit. Please contact Customer Service on 1300 850 600, during business hours (8.30am-5.00pm, Mon to Fri), before completing this application.
PROPERTYSIZE / >499
s/mtrs / 500-1,199
s/mtrs / 1,200-2,499
s/mtrs / 2,500-4,999
s/mtrs / >5,000
s/mtrs / >10,000
s/mtrs
Dogs / 1 / 2 / 2 / 3 / 3 / 3
Cats / 2 / 2 / 2 / 2 / 2 / 2
ANIMAL OWNER DETAILS :( Owner must be over 18 years)
Owner’s Name: / DOB:Residential Address: / Postcode:
Postal Address (if different): / Postcode:
Home Ph / Business Ph / Mobile
Email Address:
Do you authorise the Shire to provide your telephone details to a third party for the purposes of reuniting you with your pet if it is lost? / YES / NO
Pension Concession Card No(Does not apply to health care card):Attach proofsee below
ANIMAL DETAILS:
Animal Type: / DOG / CAT / Animal Name:Address where animal kept:
Animal Date of Birth:
Animal Breed:
Animal Colour:
Animal Gender: / MALE / FEMALE
Desexed:(Please attach proof) see below / YES / NO
Descriptions / Details:
Microchip Number(Please attach proof) see below
Proof of microchipping / desexing and copy of both sides of pension card (if applicable) must be attached to this application for the Registration to proceed.
ANIMAL REGISTRATION APPLICATION FORM
For Dog Registrations only:
IMPORTANT NOTICE - REGARDING RESTRICTED BREED DOGS
The state Government has made significant amendments to the Domestic Animal Act 1994in relation to the keeping of 'RESTRICTED BREED DOGS'. A 'RESTRICTED BREED DOG'means a dog of a breed whose importation into Australia is prohibited under the Customs (ProhibitedImports) Regulations 1956 of the Commonwealth. These breeds include:Dog Argentino, Fila Brasileiro, Japanese Tosa,American Pit Bull Terrier, Pit Bull Terrier, Perro de Presa Canario and Presa Canario.
A declaration is required stating that the breed of dog has been correctly identified by the owner.
Declaration:
I declare that the dog identified in this certificate has been correctly indicated as to whether it is or not a restricted breed as listed above.
Date:Signed:
Name (print):
REGISTRATION FEES for the 2016-17 Registration years (Full year charge).
Pension Concession(Proof must be supplied see previous page)Does not apply to Health Care CardsTotal Fee / Total Fee
Dog(Desexed) / $37.50(includes $3.50 Govt Levy) / Dog(Desexed) / $20.50 (includes $3.50 Govt Levy)
Dog Entire / $175.00(includes $3.50 Govt Levy) / Dog Entire / $89.00 (includes $3.50 Govt Levy)
Cat(Desexed) / $36.00(includes $2.00 Govt Levy) / Cat(Desexed) / $19.00(includes $2.00 Govt Levy)
Dog (over 10yrs old) / $37.50(includes $3.50 Govt Levy) / Dog (over 10yrs old) / $20.50(includes $2.00 Govt Levy)
PAYMENT METHODS
- Credit card - fill in details below or Customer Service will telephone you if you do not wish to provide your Card Details
- Email:- or fax 5986 6696
CREDIT CARD PAYMENT: Mastercard Visa Card
Cardholders Name: ______
Card No: _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _ Exp: _ _ / _ _ Amount: $ ______
Cardholders Signature: ______
- Cheque/Money Orders made payable to: Mornington Peninsula Shireand send to
Mornington Peninsula Shire Private Bag 1000 Rosebud Vic 3939
In person during Office Hours: - 8.30am -5.00pm Monday to Friday
- 2 Queen Street Mornington 21 Marine Parade Hastings
- 90 Besgrove Street Rosebud 14 Edward Street Somerville
The Shire is collecting personal information on this form in accordance with its legislative powers and functions and it will only be used and disclosed in accordance with those powers and functions. You may access the information by contacting the Shire.
DOC ID: A5767130
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