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Council

Change of Address Form

NOTE: Any personal information submitted to the City of Campbelltown will be dealt with according to the Freedom of Information Act (1991) and Council’s Privacy Policy.

Change of Mailing Address

This change applies to (please tick applicable)

Rates Dog Registrations

Property Reference Number:

Property Address:

Existing Information

Surname or Business Name:

First and Middle Name:

Home Phone Number:

Mobile Phone Number:

Email Address:

Previous Mailing Address:

New or altered information (leave fields blank if same as above)

Surname or Business Name:

First and Middle Name:

Home Phone Number:

Mobile Phone Number:

Email Address:

New Mailing Address:

Declaration

By checking this box, I declare that the information I have provided on this form is true and correct to the best of my knowledge.

I have provided this under the authority of:

Self

Power of Attorney

Executor

Other (please specify)

If you selected "Other" above, please specify (otherwise leave blank)

Full Name:

Daytime Phone:

PO Box 1, Campbelltown SA 5074|172 Montacute Road, Rostrevor|(08) 8366 9222

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