FORM OF WRI'TTEN RETU RN OF INTERESTS SUBMiTrED UNDER CLAUSE 4.18
-Disclasuru by Councillors and Designated Persons' Return
DFHCE U$E ONLY Date Recetwd:
Received by:
REAL PROPER'lY A.
time since 3o June return date/at
c. S
Nature of interest
SOURCESOFINCOME
B
t to receive from an occupation in the period commencing on the first day after the return date and ending on the following 3o June
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Description of Occupation Name and address of employer or description of ofRce held (if applicable)
Name under which partnership conducted (if applicable) conducted (if applicable)
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i 7hepuunhyintaesls and othermattas to be dliclasedln tlB Blum anlte puunbaiyKiterests ar)a OlnermalLus m [nulxw uunluln leLulflul=
ptemibed by schedule xqthr Model Cede af ConductlbrLocal Caundls in 2 !f this i$ thejint ntvmyou havre been fzquiredta lodge wi& the genera!
vtmagu afar bKaiNng a councillor ar designated penang do nat camptete Parts C. D and laf the tatum. Atlathu para tithe !Blum should be camplefed with appruprhte irlfonnatiDn based onyour cfKumstanca at the ream date. that 4, the date an whkhlou bwamea cwncillor ordes©nated persm.
3. !fyou haw prwiwsiytodged a letum with thegenerut managuarldyou an canpletmg b ieNmjbrthe purposes qdiscloshga newinterest that w©
nat dbdosed tn the last return yw lodged whh the genera! managua yw quist wmplete atl paM ofthe leNm with apprapriaR ll$brmadmFir Me periadfran 3o Jude a#the prw:awjinancid ywr or the date on which you became a des©natedpenan (V iclKnrB th€ 1da'date) b the return date whl& is th e date you becatne kwan afthe new integer ta be disdosed in
[ednNm.
4. gryouhawp/evlwsVI(xlged a alum wfM thegenemlmanagerandam submftdna a newletum fbae newfnandalypar Jau mwt complete a nibmittlng a newletuml& the newfnancialyear you mwt complete all paM qae retin with appropriate h®rmaUmlbr then-month period nommuKing on 3o June n#the prwiaus year to 3a June thb yeu.
$ TtBfarmmust bf completed usbig bladcktUs wtyped.
$. 1Kttlen is ins\didentspaajbraU the irlbmia6onyw aniequiredto declan, Jouawst attacll M appended wfikh B ta b€ plupedy dmt#ibd and shred byob.
?. if&ereannopKuniaiyintensts are&ermatten gtln bndrequiredtabe diKlosed under a heading in thislblm, the wod 'NIL ' b to be placed in arl appropriate space under that heading
IMPORlnNTINFORMA'LION
11 g WWWW= m $8Ql; H H is :BHfE'ng:Hs=: ll HBB :$ H iil5Wi;i ,-""':: ::: m«-*-"
HHi31EBI : i='.gmm=£::E B H EI MliB11=111...
returns at a council meeting.
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the Government Infbrmatian(Public Access) Act zoos. the Gavemment Information(Public Access) Regulation zaog and any guidelines issued by the Information Cammlssioner.
You have an ab igation to keep the irvfarmation contained in this return unto date. tf you become aware of a new interestthat must be
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becoming aware of the pnviously undisclosed interest.
DISCLOSURE OF PECUNIARY INTEREST AND OTHER MATTERS
bY. ..'asat 3o September 2021
'' "'"'' , ';;==3
ein respectaf the period atom I July 2020 to 3o June 2021 . ...-.--...
/
(datedz. Sources of income I reaso
retum date and ending on the following 3o June;
Sources of other income I received at any time since 3o June.
indude
Q'om wlaathcom$ Was nce&eO
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Name and address of settler I Name and address nf tn istPe
X/7 c.-
P$scription of each gift I received at any time since 30 June Name and address of donor
,A/7C,
m i
Name and address of each person who made any financial or other contribution to any travel undertaken by me at any time since 3o June
Date on which tnvel was
undertaken Names of States, Territories of the Commonwealth and overseas countries in which tmvpl w=q I indprt= kPn
Name and address of each corporation in which I had an interest or held a position at the retum date/at any time since 3o June.
Name of interest (if any)
Description of position(ifany)
Description of principal objects (if any) or
corporation (except in case
/L'f{..-
WERE YOU A PROPERTY DEVELOPER OR A CLOSE ASSOCIATE OF A PROPERTY F
DEVELOPER ON THE RETURN DATE? (Y/N)
/u''L
DEBTS
H
to whom I was liable to Name and address of each
/UL-
debt at the return date/at qnv time since 3o June
DISPOSITIONSOFPROPERTY
1.
d piiperty)atany
a. Particulars of each disposition of real property by me
part. the use and benefit of the property or the time since 3o June as a result ofwhich I retained. either wholly or in
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Name of each trade union and each professional or business association in which I held any position (whether remunerated or not) at the return date/at any time since3oJune
liescnptlon orrosulan
,z# zc£-4 r?E /7-V
z. Particulars of ' each disposition af 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 JuneJ as a result
of which I obtained. eithq
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