Principal Place of Residence Declaration

                                                    Principal Place of Residence Declaration Form



1. Property details
Property Number
Address of Property


Suburb                                                                   State QLD                               Postcode


2. Applicant details
Name/s of owner/s who reside at the property
Given Name/s                                                                       Surname
Given Name/s                                                                       Surname
Given Name/s                                                                       Surname
If applicable - Name/s and address details of owner/s who do not reside at the property
Given Name/s                                                                       Surname
Residential address


Suburb                                                                              State                        Postcode
Given Name/s                                                                       Surname
Residential address


Suburb                                                                              State                        Postcode

Current postal address                              Write “As Above” if the same as your residential address


Suburb                                                                              State                        Postcode

Is the above postal address the same for each owner? Yes                                               No      Provide details at 3. below
Tick the relevant box

Do you own any other properties in the NSC area?                                    No                 Yes     Provide details at 3. below
Tick the relevant box

Home phone                                          Work phone                                         Mobile

Email address                                                                                          Fax
Name
Council will update your record with the contact details you provide on this form

3. Additional information




4. Please read the definition of Principal Place of Residence and sign the declaration on page 2
Privacy - Noosa Shire Council will only use the personal information collected for the intended purpose, to remain in contact with you regarding your
request and the legitimate functions and services of Council affecting your property. Council is authorised to collect this information in accordance with
the Local Government Act 2009 and associated laws. Access to your personal information will only be provided to appropriate Council employees and
authorised officers. Your personal information will only be disclosed to third parties with your consent, or if required to do so by law. Your personal
information is handled in accordance with Council’s Privacy Policy.




NOOSA COUNCIL                           PO Box 141                    P. (07) 5329 6500                [email protected]
ABN 97 969 214 121                      TEWANTIN QLD 4565             F. (07) 5329 6501                www.noosa.qld.gov.au