Rural Road Address Number Request Form - Western Downs Regional Council printable pdf download

Rural Road Address Number Request Form - Western Downs Regional Council

Rural Road Address Number Request Form

Customer Details

Surname:

First Name:

Postal Address:

Suburb:

Postcode:

Phone (h):

Phone (w):

Phone (m):

Fax:

Email Address:

Property Details

Property Number:

Property Address:

Suburb:

Postcode:

Property Description:

Lot No/s

Plan No

The above property has either been split from another assessment or a building has been erected upon it, with a rural road number now being

required to identify the property.

Please place rural road number at property and advise the new rural road address number.

Customer Signature

I, as owner request Council to organise a rural road number for the above property.

Date:

Office Use Only

Person In Field Installing Rural Road Number to fill out

Assigned Rural Road Number:

Road Name:

Date Rural Road Number

Installed:

Name:

Signature:

Revenue Officer to fill out

Revenue Officer entered on the Authority System:

Yes / No

Date:

Name:

Signature:

Postal address: Western Downs Regional Council, PO Box 551, DALBY QLD 4405

Rural Road Address Number Request Form - Western Downs Regional Council