I/We First Name* Last Name* and First Name Last Name hereby make an application for a Tenancy Agreement in respect of one dwelling house only upon a lot of State Land situated at Lot#/Lp#* Address Line * City* .I/We First Name* Last Name* and First Name Last Name certify that the information given in this form is true to the best of my/our knowledge and belief. If there is anything given in the information above which is not true or incorrect, knowingly or unknowingly the the Land Settlement Agency reserves the right to refuse this application.