Non Residential Roll - Individuals Application

Claim for inclusion on the roll of non-resident owners of rateable land or the roll of occupiers and ratepaying lessees for Tamworth Regional Council.

Instructions: This form must be received by the general manager of Tamworth Regional Council by 6:00pm (AEST) Monday 5 August 2024.

Do not use this form if you need to nominate an elector. Use the Non Residential Roll - Nominee Application form instead.

Note: A person may not be enrolled or vote more than once in a Council area. If you have a claim for enrolment in more than one location and you are a resident in the area, you may only be enrolled for the location of which you are a resident.

Section 1 - Property details

Lot #:*

DP/SP #*

For ratepaying lessees only - Rates assessment number

Suite/Level/Unit/Street Number & Street Name*

Town/Suburb*

State*

Postcode*

Council*

Section 2 - Claimant's details

Surname*

Given name(s)*

Date of birth*

Residential address*

Phone number*

Email address*

Postal address (if different to residential)

I am (tick one)*

Owner

Ratepaying Lessee

Occupier of the property described in Section 1

I am entitled to enrol and claim the inclusion of my name on the roll of non-resident owners of rateable land or the roll of occupiers and ratepaying lessees for Tamworth Regional Council*

I am already enrolled in Tamworth Regional Council*

Yes

Claimant signature* - required

Please type your signature

Please sign here

Section 3 - Statement by witness

I am of or above the age of 18 years. I saw the claimant sign this claim, and believe, to the best of my knowledge that the statements in the claim are true.

Witness surname*

Witness given name(s)*

Witness signature* - required

Please type your signature

Please sign here

Privacy Statement

Personal information supplied to or collected by Tamworth Regional Council will only be stored and processed by Council for lawful purposes directly related to the functions and activities of Council. Any personal information supplied will only be disclosed to a third party for the purpose of performing a lawful function or activity and for no other purpose. Disclosure of personal information to a third party will be in accordance with Tamworth Regional Council's Privacy Management Plan (PDF 331.7KB).

Mandatory field(s) marked with *