Adjoining Property Application Form

Applicant's Contact Details

Surname *

Given names *

Residential address *

Postal address *

Phone number Enter in phone number without spaces

Mobile number * Enter in mobile number without spaces

Email address *

Section 152 of the Local Government Act "if two or more pieces of contiguous rateable land are owned by the same owner and occupied by the same occupier, only one fixed charge may be imposed against the whole of the land".

I do solemnly and sincerely declare that the properties listed below are owned and occupied by the same owner/occupier.

Adjoining Properties

1) Assessment number & Property Address *

2) Assessment number & Property Address *

3) Assessment number & Property Address

4) Assessment number & Property Address

5) Assessment number & Property Address

6) Assessment number & Property Address

7) Assessment number & Property Address

8) Assessment number & Property Address

9) Assessment number & Property Address

10) Assessment number & Property Address

I request that only one fixed charge be applied to Assessment Number: *

Applicant's Declaration

As the applicant and owner of the above properties, I agree that: *

Should at anytime the ownership or occupation of the above named properties change, I agree to notify the City of Port Lincoln immediately, resulting in the fixed charge being reinstated and charged accordingly.

Date of Application *

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Adjoining Property Application Form

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