41 Wolfram Street

PO Box11,WESTONIAWA 6423

T:(08)9046 7063

E:

W:

EnrolmentEligibilityClaim
LocalGovernmentAct1995,S4.32(2)
PERSONMAKINGTHECLAIM2 / Family name:
Mr/ Mrs/ Ms/ Miss
Othernames:Date of birth:
Businessname:
POSTALADDRESS / Noandstreetname:
POBox:LocalityPostcode:
CONTACTNUMBERS / Work:Home:Mobile:
Email:
RATEABLEPROPERTYONWHICHCLAIMISBASED4,5 / Noandstreetname:
LocalityPostcode:
ENTITLEMENTTOBEENROLLED
(tickone box) / IamontheStateorCommonwealthelectoralrollinrespectofaresidentoutsidemy electorate.Myaddressshownonthatrollis:

ornotontheStateorCommonwealthelectoralrollbutIamqualifiedasanelectorunderclause 12 ofSchedule9.3oftheLocalGovernmentAct19956
DETAILSOFOWNERSHIPOROCCUPATION3
(tickone box)
***This relates only tothe portion ofthe property thatyou own or lease / Inrelationtotherateablepropertyonwhichtheenrolmenteligibility claim isbased,***Iam:
ThesoleownerofthatpropertyThesoleoccupier*of thatproperty
Oneor2co-ownersofthatpropertyOneor2 co-occupiers*of thatproperty
Oneor3ormoreco-ownersofthatpropertyOneor3ormoreco-occupiers*of that
property
AndIhavesuppliedawrittennominationsigned7byalloramajorityofthoseowners/occupiers*for thepurposeofbeinganelector
FOROCCUPIERSONLY3
(tickone box) / Idodonothavetheright,underalease,tenancyagreementorotherlegalinstrument,to be incontinuousoccupationofthepropertyforatleastthenext3months.
CLAIMANDDECLARATION
(making a false declaration is anoffence) / Iclaimeligibilityto havemynameincludedonthe Shireof WestoniaOwnersandOccupiersRoll.
Ideclarethatallofthedetails set outabovearetrueandcorrect.
Signature / Date:

Pleasereturn totheShire ofWestonia,POBox11,WESTONIAWA6423

See accompanyingformfor notesonwhen1and howto completethis form. All sections mustbe completed for the ShireofWestoniatoconsiderthe claim.For any assistance please contact9046 7063.

NOTES TOTHE ENROLMENTELIGIBILITYCLAIMS FORM

1 / Whento usethisform / Youmay makea claimforeligibilityusingthisformatanytime.However, ifyouwantto beontherollfora particularelectionyoumustgiveyourclaimform totheShireofWestoniamorethan50daysbeforetheelectiondate.
2 / Who shouldusethisform / Youshouldfillin thisform ifyou:
  • Ownoroccupy3rateableproperty inthe ShireofWestoniabutarenotontheresidentsrollfortheShireofWestonia; or
  • QualifyundertheLocalGovernmentAct19957*; andwantto beableto voteatShireofWestoniaelections.

3 / Who isanoccupier / To qualifyasanoccupieryoumusthavea right,undera lease,tenancyagreementorotherlegalinstrument, to beincontinuousoccupationoftheproperty foratleastthenext3months.
WhentheChief ExecutiveOfficeroftheShireofWestoniaisconsideringyourclaim,hemayaskyouforacopyofyourleaseortenancyagreementto supportyourclaim.Youdo not need to provideacopy unlessasked.
4 / Silentaddress / Ifhavingyouraddressontherollwouldputyoursafety, orthatofyoufamily, atriskyoumay asktheChiefExecutiveOfficernotto show youraddress ontheroll.To dothisyoumustgiveto theChiefExecutiveOfficerastatutorydeclarationsettingoutthereasonswhy youdo notwantyouraddressshownontheroll.
5 / Rateableproperty / Ifyouownoroccupy morethanonepropertyintheShireofWestonia,givedetailsofthemall.Addadditionalpagesifnecessary.
6 / QualificationundertheLocalGovernmentAct1995 / To qualifyundertheLocalGovernmentAct1995*youmustownoroccupyrateable
propertyinthe ShireofWestonia.
7 / Nominations / Anominationmustbemadeinwritingandbesignedbyalloramajorityoftheownersoroccupiersof theproperty(oriftheowneroroccupieris a corporatebody,besignedbyanofficerof thecorporatebody)inaccordancewiththeLocalGovernment(Elections)Regulations1997.Ifyouareanominee, anApplicationtoRegistera Nominee Formmustalso becompletedandreturned to theShireofWestoniawiththisEnrolmentEligibilityForm.
Ifa corporatebody orgroupof peopleownsoroccupiesmorethanonepropertyintheShireof Westonia,anominationappliesto allofthoseproperties.
8 / Durationofenrolment / Ifyourenrolmenteligibilityclaim isaccepted itwillremainvalidfor thenext2(orinlimitedcircumstances,next3)ordinaryelections heldfortheShireofWestonia,if youhaveenrolledasa non-residentoccupier.Ifyouwishtocontinuetoqualify asanelectorafterthat,youwillneedto makeanotherenrolmenteligibilityclaim.Fornon-residentowners,theclaimwillremainvaliduntilyouceaseto owntherateablepropertyonwhichtheclaim isbased.
9 / Confidentiality / Yourdateof birth, phoneandfax numbersandemailaddresssuppliedinthisformwillbekeptconfidentialandwillbeusedonlyby the ShireofWestoniaandtheWesternAustralianElectoralCommissionforthe purposeofpreparinglocalgovernmentelectoralrolls.
10 / Whereto sendyourform / Whenyouhavecompletedandsigned thisform,senditto theChiefExecutiveOfficeroftheShireof Westonia, PO Box11,WestoniaWA6423.Youmaysenditby postorbyotherelectronicmeansso longasitiscapableof being printedinitsentirety,includinga signature.
Ifyousenditelectronicallyyou shouldcheckthatithasbeenreceived.
11 / Changeofaddress/details / IfyouarecurrentlyenrolledasanelectoroftheShireof Westoniaandyouwishtoadviseofachangeof addressoranyotherenrolmentdetails,pleasedo notcompletethisform.Simply advisethe Shireof Westoniainwritingoftheamendeddetailstoyourenrolment.

*Clause12ofSchedule9.3ofthe LocalGovernmentAct1995refers