FORM OF WRITTEN RETURN OF INTERESTS SUBMITTED UNDER CLAUSE 4.18
'Disclosures by Councillors and Designated Persons' Return
OFFICE USE ONLY Date Received:
Received by:
SOURCESOFINCOME B
z. Sources ofincome I reasonably expectto receivefrom an occupation in the period commencing on the first day after the return date and ending on the following 3o June
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I riy I i] il H 2 iie] J d i b'l
Street address of each parcelof realproperty in which Ihad an interest at the retu rn date/at any time since 3o June
Nature of inte rest
Sources ot income Ireceived from an occupation at an time since 3o June Description of Occupation Name and address of employer or
description of office held(if applicable)
Name under which partnership conducted (ifapplicable)
Manager Building &
Environmental Health deli'\El=.=E::"i.HB: N/A
L The pecuniaryinterests and othermatters to be disclosed in this return are prescribed by schedule iof the Model Code of Candy(t/or Local Councils in NSW.
z if this is theFrst return you have been required to !odge with the general manager after becoming a councillor or designated person. do not complete
?ar ts C, D and lof the return. Ait other parts of the return should be :ompieted with appropriate information based on your circumstances at the 'eturn date. that is, the date an which you became a councillor or designated
)orson
3. ljyou have previously lodged a return with the genera! manager andyou are :ompieting this return jor the purposes ofdisctosing a new interest that was lot disclosed in the last return yau lodged with the generalmanager, you bust complete ali parts a#the return with appropriate information/or the periodjrom 3o June af the previousjinancialyear or the date on which you )ecame a designated person (whichever is the tater date) to the return date which is the date you became aware of the new interest to be disclosed in
aurupdatedreturn
fyou have previouslylodged a return with the genera! manager and are submitting a new return for the newjinancialyear, you must complete atl parts af the return with appropriate inlormationjor the zz-month period
:ammencing on 3a Jun e af the previous year to 3o June this year this form must be completed using block betters or typed f there is insu©itient spacejor al! the information you are required to lisciose, yo u must attach an appendix which is to be properly ident#ied and
;ign ed by you
f there are no pecuniary interests or other matters o#the kind required to be lisctosed under a heading in this farm. the word "NIL" is to be placed in an appropriate space under that heading.
IMPORTANTINFORMATION
This information is being collected forthe purpose of complying with clause 4.z8 of the Code ofConduct.
You must not lodge a return that you know or ought reasonably to knew is false or misleading in a materialparticular(see clause 4.20 Of the
Code of Conduct). Complaints about breaches of these requirements a re to be referred to the Office of Local Government and may result in
disciplinary action by the council, the Chief Executive of the Office of LocaIGovernment orthe NSW Civiland Administrative TribunaThe information collected on this form willbe kept by the generalmanagerin a register of returns. The generalmanager is required to table all
returns at a council meeting
Information contained in returns made and lodged under clause 4.z8 is to be made publicly available in accordance with the requirements of
the Government Information(Public Access) Act 200g. the Government Information(Public Access) Regulation 200g and any guidelines issued
by the Information Commissioner
You have an obligation to keep the information contained in this return up to date. If you become aware of a new interest that must be disclosed in this return. or an interest that you have previously failed to disclose, you must submit an updated return within three months of
becominq aware of the previously undisclosed interest.
DISCLOSURE OF PECUNIARY INTEREST AND OTHER MATTERS
Denise Lucy Galle I
I L.ienlse Lucy haile I
by. ..* asat 3o September 2021
-inrespectof theperodfrom I Julys2020 to 3o June 202a ...:Zr!#e;ligig/' .date;
rreturn periods/(designated person's signatures
14 July 2021
fdate)
z. Sources of income I r
return date and ending on the following 3o June;
Sources of other income Ireceived at any time since 3o June
! in which. that income was received) NIL
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Name and address of settler Name and address nf trt istpp
E [d laid F
Description of each gift Ireceived at any time since 10 June Name and address nf rlnnnr
Name and address of each person who made any financialor other contribution to any travel undertaken by me at any time since 3o June
Date on which travel was
undertaken Names of States, Territories
of the Commonwealth and overseas countries in which
travel \A/nq I indarta knn
NIL
FIJ
Name and address of each corporation in which Ihad an interest or held a position at the return date/at any time since 3o June.
Name of interest (if any)
Description of position (if any)
Description of principal objects(if any) or
corporation (exceptin case of ntihlir rnmnanvl
WERE YOU A PROPERTY DEVELOPER OR A CLOSE ASSOCIATE OF A PROPERTY F
DEVELOPER ON THE RETURN DATE? (Y/N)
POSITIONS IN TRADE UNIONS AND PROFESSIONAL OR BUSINESS ASSOCIATIONS
G
Description of Position Name of each trade union and each professionalor business association in which I
held any position(whether remunerated or not) at the return date/at any time June
since NIL
DEBTS
H
Name and address of each person to whom lwas liable to pay any debt atthe return date/alppv time since zoJune NIL
DISPOSITIONS OFPROPERTY
z. Particulars of each disposition of real property by me(includinq the street address of the affected property) at any time since 3o June as a result of which Iretained. eitherwholly or in part. the use and benefit of the property orthe
at a later time http re-acquirethe pro
NIL
2
Particulars of each disposition of property to a person by any other person under arrangements made by me (including the street address of the affected property), being dispositions made at any time since 3o June. as a result
the use and benetitotthe prope of which lobtained. eitherwholly or in
NIL
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DISCRETIONARY DISCLOSURES NIL
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