Local Heritage Assistance Fund Application Form Please complete the following application form to preserve places and buildings of heritage significance within Forbes Shire Local Government Area. Name: Full postal address: Contact telephone: Email address: Date: Signature Type It Draw It Clear Print your name Please type your signature Please sign here The proposal Street address: Owners name Present use of the building: Proposed works: How will your proposal contribute towards the maintenance and heritage conservation of your building, or contribute towards the education and/or celebration of heritage in the community: The following information is required to accompany all applications Quote for the cost to carry out the project Letter from the owner of the land confirming consent for the project if the applicant is not the owner For proposals relating to the carrying out of work on a building, the following additional information is required Plans of the proposed works Photographs of the existing structure Sample of finished materials/colours I/we hereby apply for financial assistance under the Local Heritage Assistance Fund to carry out the works described in the application on the land specified in this application Applicant declaration Owner declaration Should you have any enquiries regarding this application, please contact Councils Town Planner on (02) 6850 2300 (Option 1)