Victorian Civil and Administrative Tribunal

Land Valuation List

APPLICATION No: -----/-----

STATEMENT OF SERVICE OF DOCUMENTS

I, ...

(name)

of ...

(address)

..

state to the Victorian Civil and Administrative Tribunal that at

(time of day):

on (date of service): at

(place of service):

I served the documents, copies of which are attached to this statement, on the persons
whose names, addresses and, where relevant, position in an organisation, are set out in
the attached list,

by:

(method of service)

Signature:

Date of statement:

Attached documents:

Attachment 1-One set of copies of every document served, including any covering
letter.

Attachment 2-List of names, addresses, and (where relevant) position in the

organisation, of persons served.