GIPA/2016/
ACCESS TO INFORMATION APPLICATION
Government Information (Public Access) Act 2009 (GIPA)
* Please note requests can take up to 20 working days to be completed depending on the
complexity of the request and volume of requests Council has received.
APPLICATION DETAILS
Site Address:
Lot/Section/DP
APPLICANT'S DETAILS
Salutation: (please tick)
Mr
Ms
Miss
Other (please specify)
First Name:
Surname:
Street Address:
Suburb:
Postcode:
Postal Address
(if different to street address):
Suburb:
Postcode:
Phone No:
Mobile:
Email:
DOCUMENTS REQUESTED (Please tick the applicable box)
Please note that documents relating to Development Applications from 2008 onwards
(excl. submissions & floor plans) are available on Council's website
www.lmc.nsw.gov.au
□
DEVELOPMENTHISTORYofProperty(accesstofiles,developmenthistory&
maximum of 50 photocopies of A4/A3 documents).
$100 Fee however additional charges apply for more than 50 photocopies & copies of larger documents
□
FORMALREQUESTunderGIPA(accesstofiles)
$30 Application Fee and $30/hr processing charge. First hours of processing request is included in
theApplication Fee. Photocopying charges in addition to the above fees also apply.
Subject Matter of Formal Request
□
INFORMALACCESS underGIPArequestforspecificdocument/s
$0 application fee *photocopying charges apply:
Subject Matter of Informal Request
* please note that due to privacy and GIPA legislation Council cannot provide the personal details such as name,
address and phone number of complainants but only the content of a complaint.
Inner West Council – Leichhardt
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xxxxxxxxxx@xxx.xxx.xxx.xx
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Updated: June 2016
Access to Information (GIPA)
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PO BOX 45, Leichhardt NSW 2040
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GIPA/2016/
DECLARATION
1. I acknowledge that for a request under GIPA there is a charge to provide copies of documents.
2. I understand that
I must seek the Copyright Owners’ Consent for copies of internal floor plans and the Copyright
Owner to use any part of a copyright document for any other purpose.
3. I understand that information provided with this application (including the application form) and any subsequent
information submitted as part of this application, may be disclosed under the provisions of the Government
Information (Public Access) Act 2009 and correspondence from Council may be made available for viewing by the
general public.
4. I acknowledge that if I do not view the documents requested within one month of notification, that I will be required
to submit another Application Form and you must again pay any applicable fees.
5. I acknowledge Council’s Policy that Informal Requests under GIPA can only be made for 4 files or less and only
two applications in a six week period, otherwise a Formal Request will need to be submitted.
Applicant's signature:
Date:
/
/
PRIVACY STATEMENT
Application forms and/or names and addresses of people making an application is information that is publicly available.
In accordance with section 18(1)(b) of the Privacy and Personal Information Protection Act 1998 (NSW), you are advised that
all application forms received by Council will be placed on the appropriate Council file and may be disclosed to
Councillors, Council officers, consultants to Council or members of the public. Pursuant to the provisions of the
Government Information (Public Access) Act 2009, Council is obliged to allow inspection of its documents, including
any application you make. However, should you wish for your contact details to be suppressed, please indicate such on the
application form
INSTRUCTIONS FOR APPLICANTS
Lodging an application requires a completed application form, all relevant information and the payment of the
required fee.
INCOMPLETE OR ILLEGIBLE APPLICATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED TO YOU
Lodge in person – Inner West Council’s Leichhardt Customer Service Centre, 7-15 Wetheril St, Leichhardt.
Council’s opening hours are Monday - Friday, 8.30am – 5.00pm, cashiering hours are Monday - Friday,
8.30am - 4.30pm. Please note Applications must be lodged by 4.00pm.
Lodge by mail – Inner West Council - Leichhardt, PO Box 45, Leichhardt NSW 2040
Lodge by Email – xxxxxxxxxx@xxx.xxx.xxx.xx
Application wil be checked at lodgement to ensure the required information is provided
Payment – In person – cash, cheque, EFTPOS, credit card (0.8% charged on credit card payments;
MasterCard and Visa only).
Payment – By mail/Email – Cheque or complete the Credit Card Authorisation form – located on Council’s
website under About Council / Forms / General Forms. Make cheque payable to Inner West Council -
Leichhardt.
OFFICE USE ONLY
Cashier Code:
Cashier Code:
Cashier Code:
Cashier Code:
Amount:
Amount:
Amount:
Amount:
Receipt No:
Receipt No:
Receipt No:
Initial of Officer:
Inner West Council – Leichhardt
│
xxxxxxxxxx@xxx.xxx.xxx.xx
│
Updated: June 2016
Access to Information (GIPA)
│
PO BOX 45, Leichhardt NSW 2040
│
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