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Dog fee waiver/payment plan application form

Thank you for taking the time to lodge your request with the Buller District Council.

Please note for payment plans relating to registration fees and impounding fees agreed weekly payments are required.

Please attach any relevant documentation to support your application if applicable.

You will be notified within 7 working days of the decision made regarding the waiver of penalty.

If your application is accepted, Buller District Council will have the penalty amount credited to your dog owner account.

If your application is declined, you will need to discuss payment options with Animal Management staff.

Your details

Name *

Email address *

Phone

Address *

Fee waiver information

Name of the dog you request fees to be waivered. *

Tag number

Type of fee you request to be waivered. *

Penalty
Impound
Dog registration
Other

Please outline the reason for waiving the fees. *

Please supply relevant supporting evidence that assist us evaluating your request.

Comments

I agree that the information I have provided is true and correct. *