Application for Urban Address
Applicant Name
*
First Name
Last Name
Rates Assessment Number
Address
*
Street Address
Street Address Line 2
City
State
Postcode
Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Email
*
example@example.com
Name of Owner
*
First Name
Last Name
Signature of Owner
*
Existing Property Name or Number
Road Name
*
Locality
*
LOT/DP
*
Section
How many lots need a new urban address number?
*
Please attach a map indicating where entrances are located.
*
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