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Get AU Section 149(2) & (5) Certification Application

PO Box 63 Blacktown NSW 2148 DX 8117 Blacktown Telephone 02 9839 6000 Facsimile 02 9676 1657 SECTION 149 2 5 CERTIFICATE APPLICATION Application made for Certificate under Section 149 2 Date of Pick-up Urgency Fee Pick-up Post. /. /. FEES VALID FOR PERIOD 1/7/2013 TO 30/6/2014 PLEASE PRINT CLEARLY IN BLOCK LETTERS APPLICATION DETAILS Applicant Phone Applicant s Reference Applicant s Postal Address House No. Street Suburb Postcode Owner s Name DESCRIPTION OF LAND Lot No. Section DP/ DP/SP Privacy Note Personal information provided on this form will be used by Council officers only for processing purposes and where legislation requires may be referred to other Government agencies. PO Box 63 Blacktown NSW 2148 DX 8117 Blacktown Telephone 02 9839 6000 Facsimile 02 9676 1657 SECTION 149 2 5 CERTIFICATE APPLICATION Application made for Certificate under Section 149 2 Date of Pick-up Urgency Fee Pick-up Post. /. /. FEES VALID FOR PERIOD 1/7/2013 TO 30/6/2014 PLEASE PRINT CLEARLY IN BLOCK LETTERS APPLICATION DETAILS Applicant Phone Applicant s Reference Applicant s Postal Address House No* Street Suburb Postcode Owner s Name DESCRIPTION OF LAND Lot No* Section DP/ DP/SP Privacy Note Personal information provided on this form will be used by Council officers only for processing purposes and where legislation requires may be referred to other Government agencies. OFFICE USE ONLY Received by Fee Payment Prepared by Checked by The fee payment where applicable may be by cash cheque or credit card. Please complete the credit card debit authority below if this is the preferred method of payment. Please debit my Tick as applicable Bankcard Mastercard Visa Card Credit Card No* Card Expiry Date Amount. /. /. FEES VALID FOR PERIOD 1/7/2013 TO 30/6/2014 PLEASE PRINT CLEARLY IN BLOCK LETTERS APPLICATION DETAILS Applicant Phone Applicant s Reference Applicant s Postal Address House No* Street Suburb Postcode Owner s Name DESCRIPTION OF LAND Lot No* Section DP/ DP/SP Privacy Note Personal information provided on this form will be used by Council officers only for processing purposes and where legislation requires may be referred to other Government agencies. OFFICE USE ONLY Received by Fee Payment Prepared by Checked by The fee payment where applicable may be by cash cheque or credit card. OFFICE USE ONLY Received by Fee Payment Prepared by Checked by The fee payment where applicable may be by cash cheque or credit card. Please complete the credit card debit authority below if this is the preferred method of payment. Please debit my Tick as applicable Bankcard Mastercard Visa Card Credit Card No* Card Expiry Date Amount. /. /. FEES VALID FOR PERIOD 1/7/2013 TO 30/6/2014 PLEASE PRINT CLEARLY IN BLOCK LETTERS APPLICATION DETAILS Applicant Phone Applicant s Reference Applicant s Postal Address House No* Street Suburb Postcode Owner s Name DESCRIPTION OF LAND Lot No* Section DP/ DP/SP Privacy Note Personal information provided on this form will be used by Council officers only for processing purposes and where legislation requires may be referred to other Government agencies. OFFICE USE ONLY Received by Fee Payment Prepared by Checked by The fee payment where applicable may be by cash cheque or credit card. Please complete the credit card debit authority below if this is the preferred method of payment. Please debit my Tick as applicable Bankcard Mastercard Visa Card Credit Card No* Card Expiry Date Amount. .

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