Donor to Political Party Disclosure AEC Return - lndividuals FINANCIAL YEAR 2014-15 The due date for lodging this return is 17 November 2015 Gompleting the Return: o This return is to be completed by a person who made a gift to a registered political party (or a State branch), or to another person or organisation with thé intention of benefiting a registered political party. This return is to be completed with reference to the Financial Disclosure Guide for Donors to Potiticat Parties. ¡ Further information is available at www.aec.ôov.au. o This return will be available for public inspection from Monday 1 February 2016 al www.aec.qov.au. Any supporting documentation included with this return may be treated as part of a public disclosure and displayed on the AEC website. o The information on this return is collected under the Commonweatth ElectoralAct 1918. \' NOTE: This form is for the use of individuals only. Please use the form Political Party Disclosure Return- Organisations if you are completing a retum for an organisation. Details of person that made the donation Name CLIVE FREDERICK PALMER Postal address PO BOX 1538 Suburb/Town BRISBANE QLD 400 Telephone number (07) 38322044 ( ) Email address s. mole@mi neralogyy.com.au Gertification I certify that the information contained in this return and its attachments is true and complete to the best of my knowtedge information and belief. I understand that giving false or misleading information rs a serious offence. Signature Enquiries and retums Funding and Disclosure Phohe: 026271 4552 should be addressed to: Australian Electoral Commission Fax: 0262937655 PO Box6172 Email:
[email protected] Kingston ACT 2604 Office use only Date received DAR_1_indiv.