Change of Contact Details » Coolgardie Shire Council

First Name*

Surname*

Email*

Mobile*

Home phone

Work phone

OLD POSTAL address

OLD RESIDENTIAL address

NEW RESIDENTIAL address line 1

NEW RESIDENTIAL address line 2

Suburb

Postcode

New postal address line 1

New postal address line 2

Suburb

Postcode

New email address (if applicable)

New phone nuumber (if applicable)

COUNCIL RECORDS TO BE UPDATED

RatesDog RegistrationCat RegistrationCreditorDebtorLibrary MemberPlanning/BuildingOther

if Other, please expand

Would you like your annual Rates notice to be emailed?

YesNo

Are you a property owner?

YesNo

If yes, please list the Assessment numbers of the properties this change applies to

Does this change of address apply to ANY of the other owners?

YESNo

If YES, please list the name of the property owner(s) this applies to

Do you have any further information or instructions

I declare that the information i have provided on and attached to this application form is true*

YesNo