Queen Street, P O Box 404, Te Kuiti 3941, NZ. Telephone 07-878 0800, Fax 07-878 7771, Email enquiries@waitomo.govt.nz, Website www.waitomo.govt.nz
I/We solemnly and sincerely declare that:
1. I/We am/are the owner(s)/occupier(s) of the property situated at:
Valuation Reference:
2. I/We hereby declare that the dwelling house situated on the above property is uninhabitable and
is not and will not be used as dwelling now or in the future.
3. I/We hereby agree that the rating information held about this property be amended if required.
For the avoidance of doubt, an uninhabitable dwelling is classied as such when it is not connected to water
or sewerage services, has no kitchen facilities (including a means of cooking) available. The dwelling must
be in a derelict state and unable to be used in any way. There is also no intention to restore the dwelling
in the future.
Note: A Statutory Declaration must be made by 31 May to be effective for the rating year
beginning 1 July.
And I/we make this solemn declaration conscientiously believing the same to be true and by virtue of the
Oaths and Declarations Act 1957.
Dated: This day of 20
Name (please print):
Before me,
Justice of the Peace:
Ofce Use Only:
Field visit
Correction of RID and DVR
Ratepayer notied of decision.
Statutory Declaration
For dwellings that are uninhabitable and should be
removed from the Rating Information Database
279447 : BS : RR13
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