Applicant Details

Owner Name(s) *

Postal Address *

Primary Phone *

Secondary Phone

Email address

Transfer Details

As an incorrect reference number was used when payment was made, the following transfer is required between the specified properties.

Amount to be transferred from *

From Property No. *Property No. is located on the top right hand side of the rate notice.

Amount to be transferred to *

To Property No. *Property No. is located on the top right hand side of the rate notice.

Applicant Declaration

I understand that by completing and signing this application, the amount(s) specified on this form will be transferred as outlined above. *

I declare that the above details I have provided are true and correct. Mareeba Shire Council does not take responsibility for the supply of incorrect information. *

Applicant Name *

Date *

Applicant Signature *

Draw signature|Type signatureClear

Privacy Notice: Mareeba Shire Council is collecting your personal information in accordance with the Local Government Act 2009 in order to process your application. The information will only be accessed by authorised Council employees. Your information will not be given to any other person or agency unless you have given us permission or we are required by law.