Municipal Offices:

90 Bell Street
Coburg Vic 3058

Locked Bag 10
Moreland Vic 3058

Tel: 9240 1111

Fax: 9240 1212
Email: info@moreland.vic.gov.au

CHANGE OF PERSONAL NAME OR COMPANY NAME

PLEASE ATTACH MARRIAGE CERTIFICATE / NISI DECREE / DEED POLL

I hereby give you notice that I have changed my name as stated hereunder

Current Name
Family Name Given Name/s Date of Birth

Previous Name
Family Name Given Name/s

Telephone
Private Mobile
Business Email

Address where you live

Mailing Address for all Council correspondence (if different from above)

PLEASE ATTACH CERTIFICATE OF INCORPORATION

Current Company Name

Previous Company Name

Telephone
Business Email

Registered Address

Mailing Address (if different from above)

D08/67461
 Municipal Offices:
90 Bell Street
Coburg Vic 3058

Locked Bag 10
Moreland Vic 3058

Tel: 9240 1111

Fax: 9240 1212
Email: info@moreland.vic.gov.au

TO BE COMPLETED BY OWNER OF PROPERTY

CHANGE OF RATEPAYER NAME – COMMERCIAL PROPERTY

Property Address

Business Name or Lessee Name

Mailing Address

Telephone
Private Mobile
Business Email

Property Owner Signature_____________________________________Date______________________________

Owner Name
Please print ______________________________________

Personal information collected by Council is used for municipal purposes as specified in the Local Government Act 1989. Council will solely
use this personal information for these purposes and/or directly related purposes. Council may disclose this information to other
organisations if required by legislation. I understand that the personal information provided is for the above purpose and that I may apply to
Council for access to and/or amendment of the information.

Office Use Only

Officer Name_______________________________________________Date__________________________________________________

D08/67461