Municipal Heritage Inventory - Application for Amendment to Management Category Form

Please note, an * indicates a mandatory field.
Please be sure to fill in all mandatory fields.
Telephone numbers are required to be numbers only with no spaces, letters or characters e.g. 92736000.

MHI - Amendment of Category Form
Contact Details
Name: *
Address:
Telephone:
Email Address: *
The Place to be considered for Amendment to Management Category
Name of Place (if any):
Address / Location: *
Suburb: *
Supporting Evidence
With reference to the Place Record Form for the subject place, on what grounds do you think that the allocated management category is inappropriate (in your opinion)? (e.g. Inaccurate statement of significance provided, unrecognised alterations and addition as to the existing significant fabric, inaccurate physical description, inaccurate historical background etc): *
References (e.g. books, historical photographs, certificate of title, maps, sewerage plans, postal directory, correspondence, newspaper articles etc):
Other Comments:
Please upload any related documents/photographs (if more than one is necessary you can compress these into a zip file. For help on how to do this please Click Here):