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Applicant Details Office Use Only Company Applicant Site Description Reply

APPLICATION FOR A LAND INFORMATION MEMORANDUM 1 of 2 Office Use Only Application No. Date Received Time Applicant Details Name Postal Address Home Phone Cell Phone Email/Fax Company Applicant Company Name Postal Address Phone Client Reference Email/Fax Site Description To ensure your LIM reflects the correct property information, please ensure the following site description is completed. If the legal description of the property is not known please ask for assistance with completing the form, or supply a recent Certificate of Title. Street Address Legal Description Valuation Number Land Area Current Owner Reply Do you require a reply by Post Email Fax APPLICATION FOR A LAND INFORMATION MEMORANDUM 2 of 2 Payment This application must be accompanied by an application fee before processing can begin. Please tick the appropriate box below: Masterton District Council Standard $192.00 (incl GST) - To be processed within 10 Working Days Masterton District Council – URGENT $280.00 (incl GST) – To be processed within 5 Working Days. Carterton District Council Standard $250.00 (incl GST) – To be processed within 10 Working Days Carterton District Council – URGENT $350.00 (incl GST) – To be processed within 5 Working Days. South Wairarapa District Council Standard $250.00 (incl GST) - To be processed within 10 Working Days South Wairarapa District Council – URGENT $450.00 (incl GST) – To be processed within 5 Working Days. Payment Method Please tick the methods of payment used: Cash Eftpos Cheque Direct Credit Contact Details Masterton District Council Carterton District Council South Wairarapa District Council 64 Chapel Street Holloway Street 19 Kitchener Street PO Box 444 PO Box 9 PO Box 6 MASTERTON 5840 CARTERTON 5743 MARTINBOROUGH 5741 Tel: 06 370 6300 Tel: 06 379 4030 Tel: 06 306 9611 Fax: 06 378 8400 Fax: 06 379 7832 Fax: 06 306 9373 Web: www.swdc.govt.nz Web: www.mstn.govt.nz Web: www.cdc.govt.nz Email: [email protected] E: [email protected] Email: [email protected] Direct Credit: Direct Credit: Direct Credit: 02-0680-0027337-00 Westpac Masterton BNZ Carterton Particulars: Applicant Surname 03-0687-0271682-00 02-0608-0086383-03 Code: LIMS Ref: LIM Address & Surname Ref: LIM Address & Surname Ref: 31903121.

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