WAIROA DISTRICT COUNCIL
REGULATORY DEPARTMENT
P
+64 6 838 7309
F +64 6 838 8874
E consents@wairoadc.govt.nz
W www.wairoadc.govt.nz
p PO Box 54, Wairoa 4160, Hawke’s Bay
A Coronation Square, Queen Street, Wairoa
PAGE 1APPLICATION FOR LAND INFORMATION MEMORANDUM
APPLICATION FOR LAND INFORMATION MEMORANDUM
Fees
A fee of $260 incl. GST is required before your application will be processed. Refer to the payment section for the payment
options.
Applicant
Applicant's Full Name
Postal Address
Post Code
Email Address
Phone Number
Please answer all questions fully.
The Building
Address
(of property for which information is required)
Post Code
Certicate of Title
(please tick)
Copy attached to this application
Legal Description
Valuation Number
Current Owner
(full name)
Payment
Reference your payment: LIM/Property Address.
Please note processing will not begin until payment is received (or identied if incorrectly referenced).
Fixed Fee for Application for Land Information Memorandum: $260 incl. GST
I conrm payment by
Bank transfer to account 03 0785 0070470 00
Cheque payable to Wairoa District Council attached
Manual Payment at reception
Reference
Amount Paid
Date of Payment
Application & Declaration
I hereby certify that, to the best of my knowledge and belief, the information given in this application is true and correct,
and I undertake to pay the application fee of $260.00 incl. GST.
Signature Applicant
Full Name Applicant
Date
click to sign
signature
click to edit
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