Application for Review of a Dog Expiation Notice

Required fields are marked with an asterisk (*).

Applicant Details

Surname

Given Names

Residential Address

Phone Number daytime please enter your number with no spaces

Phone Number mobile please enter your number with no spaces

Email Address

Expiation Details

Expiation Number

Dog's name

Date and Time of Offence *

Day Month Year Hour Minute

Please tick all relevant boxes below

The lodgement of this application to review your dog expiation notice does not automatically cancel the expiation notice. Please tick all the boxes that are relevant, attach documented evidence (if applicable) and complete a Statutory Declaration ensuring it is witnessed and signed by a Justice of the Peace

I was not the owner or person responsible for the dog at the time of the offence. If you were not the owner or the person responsible for the care of the dog at the time, please provide your own written statement in the form of a Statutory Declaration, witnessed and signed by a Justice of the Peace, which includes the full name and address of the owner or person responsible
The dog escaped from my property as a result of an intruder. Please provide documented evidence (a police report number) as well as your own written statement in the form of a Statutory Declaration witnessed and signed by a Justice of the Peace.
My dog was registered with Council at the time of the offence. Please provide documented evidence as well as your own written statement in the form of a Statutory Declaration witnessed and signed by a Justice of the Peace.
The expiation notice received contains incorrect information such as date, time or location of offence. Please provide your own written statement in the form of a Statutory Declaration (see reverse of this form) witnessed and signed by a Justice of the Peace. Please note that a new expiation notice for the offence may be issued with the correct details.
I believe there are other circumstances to be taken into consideration. Please provide documented evidence as well as your own written statement in the form of a Statutory Declaration (see reverse of this form) witnessed and signed by a Justice of the Peace
I elect to be prosecuted for the offence shown on the Expiation notice. Please provide your own written statement outlining your reasons for electing to be prosecuted in the form of a Statutory Declaration (see reverse of this form) witnessed and signed by a Justice of the Peace

Your application will be assessed and you will receive written notification of the decision made. The notification will include a payment due date if applicable. The submission of this application does not mean that the expiation will be withdrawn.

Confirmation

Applicant name in full

Date *

Day Month Year

Upload any supporting documents and the Statutory Declaration *

Application for Review of a Dog Expiation Notice

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