Destruction Order (Information Notice)

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RD Form 5

Version 1 — June 2009

[Insert Name of Local Government]
Animal Management (Cats and Dogs) Act 2008

Section 127

Destruction Order

(Information Notice)

Owner / responsible person



I....<< insert name >>......................................... of the …<< insert council name >>..……………….. Council am authorised under section 127 of the Animal Management (Cats and Dogs) Act 2008 (“the Act”) to issue a destruction notice.

I understand that you are the owner/responsible person for the regulated dog as follows—

Regulated Dog Type

 Restricted Dog  Dangerous Dog  Menacing Dog

Regulated Dog Details

Permit number

(if applicable)

Breed or type


 Male  Female


Distinguishing marks or features

Registration number

Permanent Identification Number (PID) / Microchip

 Yes  No

Permanent Identification Number (PID) / Microchip

The reasons for the destruction order are as follows —

  • << insert reasons here>>

  • << insert reasons here>>

If you do not request a review of the destruction order within 14 days of the date on this notice council will proceed to destroy the dog.

Local Government Officer’s Signature:




A request for review of this notice must be made to council within 14 days of the date on this notice in the approved form (CEO Approved Form 4 — Application for Review of Local Government Decision attached).

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