Change of Postal Address Form
ABN
79 198 223 277
Address Central Highlands Regional Council
Enquiries 1300 242 686
PO Box 21
Email
rates@chrc.qld.gov.au
EMERALD Q 4720
Please change my name for all Central Highlands Regional Council business as indicated below (please print clearly):
Name/s in full:
Primary Property Location:
New Postal Address:
(PO Box preferred)
TOWN:
STATE:
P/CODE:
New Residential Address:
(If applicable)
TOWN:
STATE:
P/CODE:
Contact Details:
Home:
Work:
Mob:
Email Address:
Fax:
RATES (Assessment Number/s):
Is Pension Rebate granted on this
Yes
No
property?
If YES, please advise the property
Still resided in
Vacant
Rented
is to be:
If Rented, please advise the date
the property is to be rented from:
DEBTORS (Account Number/s):
DOG REGISTRATION:
Do you have a dog(s) registered:
Yes
No
Animal Tag/s No:
Is the dog registration to be sent
Yes
No
to the new postal address?
Current dog(s) Residential
Address:
Please provide new residential
address where dog(s) will be
TOWN:
STATE:
P/CODE:
located:
LICENCES:
Trading Name:
Acc No:
* This form is for change of postal address only. All licencees must sign this form. If a Manager is acting on behalf of a company,
please indicate this when signing.
BUILDING:
Property Location / Application Number/s:
OTHER APPLICATION/S:
Please specify and provide relevant details:
Please provide any other relevant information below:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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__ __ / __ __ / __ __
Applicants Name
Signature/s
Dated
OFFICE USE ONLY
Council/NAR Officer’s Name:
Date Processed: __ __ / __ __ / __ __