Attachment 1 - Form 5 and Owners' Consent

on the premises described above for:

 

 

Change application to development approval 21675 DA dated 7 December 2005 / Development Permit
for Material Change of Use for Extension to Residential Care Facility

 

Company seal [if used]

 

Company Name and ACN: Ozcare A.C.N. 072 422 925

" Signature of Sole Director/Secretary

“Date

 

[Delete the above where company owner’s consent must come from both director and director/secretary.]

 

Company Name and ACN: Ozcare A.C.N. 072 422 925

4

   

al\+

 

      

 

 

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, Signature of Sector lo
Auth ortyed a 7
seveeneee ATID I20 22.22... eect eee eee eee -.17/11/2022... ceeeeeees
Date Date
[Delete the above where there is @ sole director/secretary for the company giving the owner’s consent.]
Page 2

Applicant template 11.0
Version 1.0—3 July 2017