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
Name(s):
Address:
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. For a small scale business
I/We hereby declare that the rating unit is occupied by a small scale business and the scale of the
business does not constitute a separate part.
The following supporting documentation is required for small scale businesses:
• Formal Lease or Agreement
• Business hours
• Type of business
• Income
• Any other information regarding the business that supports your declaration statement above
Please note that Council retains the discretion to determine the number of separately used of occupied parts
of any given rating unit and the rates charged.
I/we make this solemn declaration conscientiously believing the same to be true and by virtue of the
Oaths and Declarations Act 1957.
Note: A Statutory Declaration must be made by 31 May to be effective for the rating year
beginning 1 July.
DECLARED at:
Dated: This day of 20
Name (please print):
Signature:
Before me,
Justice of the Peace:
Statutory Declaration
Part of a Rating unit is occupied by a small scale
business and should not be deemed a SUIP.
