MUNICIPAL CHARGE
Application for Exemption for Single Farm Enterprises
This application has been prepared to facilitate applications by persons seeking exemption from the
Municipal Charge for Single Farm Enterprises.
All sections of this form must be completed to allow your application to be processed. You should note that
Council may ask you for additional information in accordance with the Local Government Act 1989 (as
amended).
Applications must be lodged with the Council Rate Department. Completed application forms should
be directed to the following address:
Rates Department
Murrindindi Shire Council
PO Box 138
Alexandra 3714
Applications must be lodged with the Council Rate Department
Section 1
I / We ………………………………………………………………………………………. (full name)
hereby apply for exemption from the Municipal Charge.
Section 2
An exemption is sought for the following property (or properties) in the Murrindindi Shire.
Location (as shown on Rate Notice)
Property/Assessment No.
…………………………………………………….
…………………………..
…………………………………………………….
…………………………..
…………………………………………………….
…………………………..
…………………………………………………….
…………………………..
Note:
Please attach list if insufficient space.
In Section 2, you should only list properties in the Murrindindi Shire. If you wish
to claim an exemption for properties in other municipalities, you should lodge a
separate application with that municipality (or municipalities).
Section 3
I nominate the following property as the property for which the Municipal Charge will be paid:
Location (as shown on Rate Notice)
Property/Assessment No.
……………………………………………
…………………………..
MUNICIPAL CHARGE
Application for Exemption for Single Farm Enterprises
Please circle the correct answer to each of the following questions:
(a) The properties described in Sections 2 & 3 above are farmed as a single enterprise.
YES / NO
(b) The properties described in Sections 2 & 3 above are all each more than 2 hectares in size. YES / NO
(c) The properties described in Sections 2 & 3 above are all used primarily for farm purposes.*
YES / NO
* As defined under the Valuations of Land Act 1960, land used primarily for carrying on one or more of
the following businesses or industries; grazing (including agistment); dairying; pig farming; poultry
farming; fish farming; tree farming; bee keeping; viticulture; horticulture; fruit growing; the growing of
crops of any kind.
(d) The properties described in Sections 2 & 3 above are all occupied by the same person or persons.
YES / NO
I also accept that Council may require further information in order to determine whether this application
complies with the provisions of the Local Government Act 1989 Section 159.
DECLARATION
I ………………………………………………………………….
(Full name of Applicant)
of ……………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………..
(Address of Applicant)
I acknowledge that this declaration is true and correct, and I make it with the understanding and belief
that a person who makes a false declaration is liable to the penalties of perjury.
Declared at ……………………………………………….
In the State of Victoria, this …………………………….. day of …………………………… 20 ………..
……………………………………………………..
Signature of person making this declaration
(To be signed in front of an authorised witness)
Before me
……………………………………………………..
Signature of authorised witness
The authorized witness must print or stamp his or her name, address and title under Section 107A of the Evidence Act 1958 (Vic)
(eg. Justice of the Peace, Pharmacist, Police Officer, Court registrar, Bank Manager, Medical Practitioner, Dentist)
Persons authorized to witness statutory declarations under the
Victorian Evidence Act 1958 – Section 107A
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A Justice of the Peace or Bail Justice
A Notary Public
A barrister and solicitor of the Supreme Court
A clerk to a barrister and solicitor of the Supreme Court
The Prothonotary or a Deputy Prothonotary of the Supreme Court
The Registrar or a Deputy Registrar of the County Court
The Principal Registrar, Registrar or Deputy Registrar of the Magistrates’ Court
The Registrar or Probates or an Assistant Registrar of Probates
The Associate to a Judge of the Supreme Court or of the County Court
The Secretary of a Master of the Supreme or of the County Court
A registered Patent Attorney
A Member of the Police Force
A sheriff or a deputy sheriff
A member or former member of either House of the Parliament of Victoria
A member or former member of either House of the Parliament of the Commonwealth
A councillor of a municipality
A senior officer of a Council
A registered medical practitioner
A registered dentist
A veterinary practitioner
A pharmacist
A principal in the Victorian government teaching service
The branch manager of a bank
A member of the Institute of Chartered Accountants in Australia or the Australian Society of
Accountants or the National Institute of Accountants
The Secretary of a building society
A Minister of religion (not a civil celebrant)
A Victorian public servant with authorization to sign statutory declarations
A Fellow of the Institute of Legal Executives (Victoria)