TAX INVOICE - Banyule City Council

TAX INVOICEOffice Use Only:Receipt No: ………………………….Receipt Code: T 4Amount: $455.00Debtor No:……………………………Managed by Banyule Cemeteries TrustABN: 37 017 044 696APPLICATION FOR PURCHASE (25 YEAR TENURE)RIGHT OF INTERMENT FOR CREMATED REMAINS (ASHES) POSITIONIN A WALL NICHEI, ……………………………………………………………………………………………………..of……………………………………………………………………………………………………..telephone number ……………………. (work) …………………….. (home)apply to the Banyule Cemeteries Trust for a right of interment for cremated remains (ashes)memorial position in the Warringal Cemetery, described as“Warringal” RowNumberon the plan kept at the Banyule Cemeteries Trust Office.Submitted with this Application is the fee $455.00 (GST exempt) which is the payment forthe non-transferable right to deposit cremated remains (ashes) position that I request begranted to me by the Trust. An additional fee is payable for interment of cremated remains.I have read and understand the conditions on the reverse of this Application and haveaccordingly signed the Conditions in acknowledgment that they apply in relation to the grantof a right to deposit cremated remains (ashes) position.I unconditionally agree to comply with the Conditions should my application be successfuland attach a copy of these conditions signed by me.In accordance with the privacy statement printed on the reverse of this form, I understandthat the personal information I provide will only be used and disclosed in the provision of thestandard functions or activities of the Cemetery Trust as they relate to the ongoingadministration of this position.Signed: .................................................... Dated: ...................................................Please submit this form together with your payment.All cheques payable to Banyule City Council, PO Box 51, Ivanhoe 3079.

CONDITIONS – WALL NICHE (25 YEAR TENURE)1. The position must be used and then kept by the holder solely as a place forthe interment of ashes.2. Without the prior written approval of the Trust, the position must not be alteredor interfered with in any way.3. The holder must comply with the provisions of the Cemeteries & CrematoriaAct 2003 or any superseding legislation and any Cemetery Regulations orRules made by the Trust from time to time.4. Before any interment of cremated remains (ashes) in the position, theTrustees may inquire if the holder has consented to such interment.5. The holder’s exclusive right of interment for cremated remains expires after25 years from the date on the certificate.I have read, understand and accept these Conditions.Signed: .................................................... Dated: ...................................................PRIVACY STATEMENTThe Trust respects all personal and confidential information you give and will do everything possible toprotect information from unauthorised access, loss or misuse. Information collected from you isrequired for the delivery of Trust services in accordance with the Trust’s powers, functions andpurposes under the Cemeteries and Crematoria Act 2003 and other relevant legislation. Should youneed to change your personal details, please contact Customer Service on (03) 9490 4222.