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Introduction
Text
Property Details
Existing Information
New Information
Supporting Information
Submit Response

Introduction

Navigate through the different form sections using the navigation on the left, or use the next/previous buttons located at the bottom of each step.

Save Your Progress

You have the ability to save this form and complete it at a later date. An email will be generated and sent to the specified address.

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There is no way to resend or recover your password, please write it down.

Note: Incomplete forms are kept for a period of 7 day(s), after this time the system will automatically delete your response.

Privacy Collection Notice

The Shire of Denmark collects your personal information to deliver services and meet our legal obligations under relevant laws. We handle your information in accordance with the Privacy and Responsible Information Sharing Act 2024 and other applicable legislation. Your information is stored securely and kept only as long as required. It may be shared internally at the Shire of Denmark to aid our customer service delivery and may be shared with other government agencies if required by law. If you do not provide your information, the Shire may not be able to provide services to you.

You can request access to or correction of your personal information by contacting the Shire of Denmark Privacy Officer at info@denmark.wa.gov.au. For more information, visit www.denmark.wa.gov.au/privacy

Property Details

Assessment Number (If known, shown on rates notice)

House Number*

Lot Number (if known)

Street Name*

Suburb*

Existing Information

Title*

First Name(s)

Surname or Business Name*

Existing Address*

Home Phone

Mobile Phone

Work Phone

Fax

New Information

Title*

First Name(s)

New Surname or Business Name*

New Address (residential)

New Postal Address (if different from residential)

Email Address*

New Home Phone Number

New Mobile Phone Number

New Work Phone Number

New Fax

Is this NEW address the preferred mailing address for ALL correspondence from the Shire of Denmark*

YesNo

If NO, please provide additional comments

Supporting Information

Please upload any documentation to support this application i.e Marriage Certificate, Certificate of Title, Death Certificate, Power of Attorney or Probate Will listing the executor as required:

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Additional Comments

Use and Privacy of Customer Details

Use and Privacy of Customer Details
Personal information is received and collected by the Shire of Denmark for the purpose of providing services normally
delivered by a local government. Your personal information may be disclosed if it appears in documents that are required to be publicly available for disclosure under the provisions of the Local Government Act 1995 or any other legislation. For further information click to view the Shire of Denmark Privacy Statement

Please ensure that your postal address is accurate, as this is the only contact that the Shire of Denmark will guarantee the use of, for the purpose of communicating with you. Your other contact details may only be used for convenience.

I certify that the information I have submitted in this form is true and correct to the best of my knowledge*

AgreeDo not Agree

Name of Certifying Person (if Company or Organisation)

Date Certified*

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