0800 965 468 (0800WMKGOV)
Release of Information Form
Date of Request: Reference:
Owner Yes No
* Please Note: No Charge for Property Owner/s
to view at Council office *
Name of Applicant (incl business name if applicable):
Applicant’s Postal Address:
Site for which information is
Method of Issue: (Please tick choice)
Disk $25 USB $30
Email $10.20 (Drainage, floor & elevations plans only, up to12MB)
w File at Council offices $10.20
Please tick: Post Pick Up NA
* Please Note: This may take up to 7 working days from receipt of payment
Contact Details:
Phone #:
Photocopying Charges:
A4: black & white $0.20
colour $2.00
A3: black & white $0.40
colour $4.00
Valuation Number:
“Council has made the information available under Sections 10 to 18 (inclusive) of the Local Government
Official Information and Meetings Act 1987 ONLY. Council does not warrant its accuracy and disclaims all
liability whatsoever for any error, inaccuracy or incompleteness of the information. No person should rely on
any information without seeking appropriate independent and professional advice. The information provided
does not constitute a Land Information Memorandum or any similar document.”
(I have read and understood the content of the Disclaimer above)
Applicant’s Signature:
Council Officer’s Name:
Date Actioned: Receipt #:
QS-M560 (Is5) 7/11/2018 120521030680
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