STATUTORY DECLARATION

IN THE MATTER of the Evidence Act 1958

and

IN THE MATTER of the Planning and Environment Act 1987

and

IN THE MATTER of Planning Application No______

Address of land subject to this Planning Application:

………………………………………………………………………………………………......

I, ………………………………………………………………………………………………...

(name)

of ………………………………………………………………………………………………..

(address)

do solemnly and sincerely declare:

  1. That I am the applicant making the above application.

That I am acting on behalf of the applicant making the above application.

(State capacity in which you are acting for the applicant)

………………………………………………………………………………………………

  1. That I gave Notice of this planning permit application by placing the Notice on the land the subject of this application on the ………….. day of ………………… 2016 and have maintained the Notice in good condition until the …………… day of

……………….. 2016.

I make this solemn Declaration conscientiously believing the same to be true and by virtue of the provisions of an Act of Parliament of Victoria rendering persons making a false declaration punishable for wilful and corrupt perjury.

Signature …………………………………………….

DECLARED at ……………………………… in the State of Victoria, dated

………………… day of ………………………… 2016.

BEFORE ME:………………………………………………………………………………….

For a list of persons able to witness this declaration see the back of this form.

Any of the following persons may witness the signing of a Statutory Declaration:

Justice of the Peace or Bail Justice;

A notary public;

A barrister or solicitor of the Supreme Court;

The prothonotary or a deputy prothonotary o the Supreme Court, the registrar or a deputy registrar of the County Court, the principal registrar of the Magistrates Court or a registrar or deputy registrar of the Magistrates Court;

The registrar of probates or an assistant registrar of probates;

The associate to a judge of the Supreme Court or of the County Court;

The secretary of a master of the Supreme Court or of the County Court;

A person registered as a patent attorney under Part XV of the Patents Act 1952 of the Commonwealth;

A member of the police force;

The sheriff or a deputy sheriff;

A member or former member of either House of the Parliament of Victoria;

A member or former member of either House of the Parliament of the Commonwealth;

A Councillor of a municipality;

A senior officer of a Council as defined in the Local Government Act 1989;

A registered practitioner within the meaning of the Medical Practices Act 1994;

A dentist;

A veterinary surgeon;

A pharmacist;

A principle in the teaching service;

The manager of a bank;

A member of the Institute of Chartered Accountants in Australia or the Australian Society of Accountants or the National Institute of Accountants;

The secretary of a building society;

A minister of religion authorised to celebrate marriages;

A person who holds an office in the public services or in a statutory authority that is prescribed as an office to which this section applies;

A fellow of the Institute of Legal Executives (Victoria)