Application for a Property Identification Code - Local Land Services

4 downloads 242 Views 41KB Size Report
It may be provided to NSW Department of Primary Industries, Meat and Livestock Australia, the NSW Wine Industry Associat
Application for a Property Identification Code This form may be used to apply to Local Land Services for a Property Identification Code (PIC). Please contact your Local Land Services office or call 1300 795 299 to confirm the fee payable in your circumstances. Normally each property has its own PIC. However, one PIC can be used for more than one property provided the properties are used for a common purpose (eg to graze the same livestock) and are proximate (adjoining or nearby). If you wish to apply for a PIC to cover more than one property, please complete a separate form with the property and owner details for each property and submit all forms together. For more information on Property Identification Codes go to the Local Land Services website at www.lls.nsw.gov.au/livestock APPLICANT DETAILS Full name

 

 

Title (eg Mr, Mrs, Ms, Dr)

Postal address

   

 

Postcode

Phone numbers Home:

Business:

Mobile:

Email address

PROPERTY DETAILS Address (actual location of the property – write ‘as above’ if same as postal address)

   

Postcode

 

Title

 

Property area

hectares Lot/DP for this property Lot:

(from your Council rates notice)

DP:

PROPERTY OWNER DETAILS (if different to the applicant, otherwise write ‘as Full name

above’)

 

(eg Mr, Mrs, Ms, Dr)

Postal address

    Home:

Phone numbers

 

Postcode Business:

Mobile:

I declare that I am the (tick one): Owner of the property

Lawful occupier of the property

Authorised representative of the owner

 

Date:

SIGNATURE:

/

/

Please return this completed form to your Local Land Services office. Privacy notice: This information is being collected for the purposes of assigning a property identification code in accordance with the Stock Diseases Act 1923. It may be provided to NSW Department of Primary Industries, Meat and Livestock Australia, the NSW Wine Industry Association and other persons for purposes consistent with that Act, the Plant Diseases Act 1924 or the Rural Lands Protection Act 1998. It will be stored securely by Local Land Services and any person who is authorised to obtain the information. You may access or correct this information by contacting Local Land Services. For more information go to www.lls.nsw.gov.au

OFFICE USE ONLY PIC:

N

Receipt number: Application for Property Identification Code

Holding reference: Fee paid: $ 03-05-2017

Date:

/

/