Online Form - Appeal an Infringement

Instructions

Please complete the following form with as much details as you can to help us process your request in a timely manner.

This form is only to be used for non-urgent requests, for any urgent or dangerous issues, please call the Shire of Denmark on (08) 9848 0300

Please note that we take your privacy seriously and will not disclose your details to any third party without prior permission.


Contact Details

What is your preferred method of receiving correspondence

Infringement Details

I certify that the information I have submitted in this form is true and correct to the best of my knowledge, I am aware that it is an offence to provide false and misleading information. *

 
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