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 *

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Privacy Notice: Mareeba Shire Council is collecting your personal information in accordance with the Local Government Act 2009 in order to process this application. If you choose not to provide your personal information, the application may not be approved. Your personal information will only be accessed by authorised Council employees. Your personal information will not be used for any other purpose or disclosed to any other person or entity unless you have given us permission or we are required by law. Please refer to Council’s QPP Privacy Policy for further information on access or correction of personal information held by Council.