Extension request REC16-0022 · REC16/0022.01

    Application no.          Amount paid       Date paid           Receipt no.                               Date stamp


    ieceiving Officer




    !n
      person , I Pelican Street, Tewantin: 8 30 am to 4,30 pm Monday to Friday (excludes public holidays).
    By   mail       ,
                        Cheque or money order to, be made payable to Noosa,Counc!1.
,                      Cheque
                        [3                       ,E Money order                ,
                                                                                   tr Masterca!               tr Visa
,                   rCard number                                                   Expiry   date              Amount $
                        Name on card                                               Signature of cardholder
                        Phone                                                      ls a receipt required? tr     Yes         tr No
,   Ail payments made by credit card will incur a 0.50% surcharge (exempt of GST) to reflect the cosf of fees charged for credit card
    transactions.



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