Renewal of Kennel Licence

FORM 12 TASMANIA

DOG CONTROL ACT 2000

Applicants Name(Required)

First Last

Postal Address(Required)

Street Address Suburb State Post Code

Phone(Required)

Email(Required)

Renewal of Licence to Keep:(Required)

Breed(s) or Kind(s)

Number of Dogs

Registration Number(s)

Type of Enclosure(Required)

At my Premises:

Street Address Suburb State Post Code

Full address of kennel location

Declaration(Required)

I undertake that all the requirements of the Dog Control Act 2000 and the relevant regulations will be observed in relation to the keeping of dogs on these premises

Licence holders should be aware that failure to comply with the conditions listed on the licence may result in the cancellation of non-renewal of the licence.

Signature(Required)

Date(Required)

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