Change of details

1. Property details

2. Assessment number if known
3. Property address*

4. Primary owner/occupant

5. Full name*

   Upon receipt of this information these details will be noted as the primary contact address where Shire correspondence will be sent

6. Residential address*
7. Postal address*
8. Phone
9. Mobile
10. Fax
11. Email
12. Emergency contact

    If you would like to provide an alternate contact for Shire wide emergency situations complete the following including name, day and night time phone, mobile and email if available.

13. Secondary owner/occupant

14. Full name

    If there are more than two owners, please complete an additional form

15. Postal address
16. Phone
17. Mobile
18. Fax
19. Email
20. Emergency contact

    If you would like to provide an alternate contact for Shire wide emergency situations please complete the following including name, day and night time phone, mobile and email if avail

21. Company details

    If you are an owner of a company, please advise of all Directors by emailing amrshire@amrshire.wa.gov.au

22. Declaration

23. I hereby declare that I am authorised to make the above changes to the name and address details of the persons named above. I understand that it is illegal to provide false or misleading information. I agree
24. Full name of person who is completing this form*

* denotes a required field.