request for a congratulatory letter - queensland parliament€¦ · request for a congratulatory...
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25, FEB. 2010 12:29 ROS BATES MP - 07)55690675 O. 3260. P. 2
Queensland GovernmentDnpanment or the PMmk and Cnbid4t
Request for a Congratulatory LetterFUJI name of person/couple celebrating birthd,jy/anniversary
Please tick approprlpte title Q• Mr a Mrs OMr Q Mrs Q MMs Q Miss Q Dr
iirsr name
liimtn ame
Residential addresO
last nomil
bast name
postcodeAddress for message (ifdiferent m residential address)
F^'-1 r^ r2i=t /1
An niversary/birthday
Wedding
Birthday
Verification provided
We4din
Birthday
postcode
50 years Q00 years 0 65 year's Q 7o years Q Pther_year5
Q' 90 Yezirs O 100-yedrs QOther years
erMarriegecl~rkifieata Q Statutor}ydeclaration Q other
Q Birth oeMiffcete O Statu(dry declaratlpn Q prher
Date of anniversary /birthday ^^rl q ^ 9 Date message preferredfifrequfrsd earlier)
l5%o &y z 7Contact details (person mahi'ng raquast)
name ra! h n^ _ - tctrg.
certifi cation by State Member of ParlIamont (if submitted through their office)
A
The original verlficatlon document indicated above has been sighted, A copy is attached with this form.
Date /
(Memberfor
OFFICE USE ONLYThis rorm has been forwarded to the following offices:
O State Member O Electorate Office Receivedq Government House Q Prime Minister
,MP)
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25,FEB,2010 12:29 ROS BATES MP - 07)55690675
0-iMUDGEERABA PREMIER DEPT MCU
Request for a Congratulatory Letterfull name of person / couple celebrating b' hday f anniversary
Please tick appropriate 0 r & Mrs Q Mr
Address for message (ifWWJferr 1ft fro rn residential address)
Anniversary/ birthday
Weddir:g
Pi fthth r
Verificarion ptevided
Wedding . ,
8irtiTdayl=
NNO. 3260 P P. 32
Queensland Government0ep5Piment of N PmM1vr ,Ind UhTfl
O Miss Q Dr
postcode
postcode
Q so years (;bo years () 65 years Q 70 years Q Other- ye;2rs
Q 9o years Q 100 years QOther-_m,,,, years
Q Marriage cerhi1i,cate Q Statutory desla,ration
Q birth cer rotate Q Statutory declaration
pets of anniversary/birthday ...
Contact details (person making request)
name
address
telephone
Certification by State Member of Parliament Of submitted through their office)
The original verification document indicated above has been sighted, A copy is attached with this form.
Date
(Memberfor
OFFICE USE ONLYThis form has been forwarded to the Following offices;
Other
(D Other (gy1,i
7//'/G`
Date message preferredGfrequire d earlier)
MP)
a r25. FEB, 2010 I) 12:29) ROS BATES MP - 07) 55690675memo Ili - v i i 6 v v J I V' J c
sman TO:MUDGEERABA PREMIER DEPT MCUE X. j Department of the Prime Minister and Cabinet
n sU
4 PREM.rNO, 3260' EP, 4'101(002 :
Request for Congratulatory Message
TO From 'u ' ^
Awards ondNaaianal , 4 --sft ol5 5xaach1)op3rtm0lns of the Wime
MARGARET MAY MPFEDERAL MEMBER FOR MCPHERSON g
MSn63rCC and Cabinet3-5 Nadowl Circuit
1 045 GOLD COAST HIG I-lWAY - ^ J,Ab.BARTON ACT 2600 PALM BEACH 0. 4221 .
^j } 7j
Pb (02) 62715620 (07) 5525 0688 l ^^JPax (02) 62715662 (07) 5525 0477
congrarutatory, mesbo ges@pmc._;CV-RU
Nominee(s) Mrs Elsie Mauby(include title Mr, Mrs etc)
55 Saunders DriveNominee(s) Address Bonog Qld 42i
Address for Message As above(}fd(fferenrfrom above)
Occasion 104'1 Birthday
Date of Annivetsary/Birthday31 July 2009 Date Message should arrive AS/ I'
Certification bySenator/Member oT
BO that information ...,,,.,...,.....,.A7mandaBelton .... ................ Date 15/07/2009
provided is correct ..(iRTduda Be^W1t - Et^tVmo officer Si .turf '
Yes No Type of verification eg, Birth certificateVerification, of
A.nni.versary/Bi'rtl dayF71
Barth cErtifivaw
Sighted L(?lease Tick oac Box)
PLEASE,0VISE THE AWARDS AND NATIONAL SYMBOLS BRANCH IATELY IFCYRCUMSTANCES ARISE WHICH MAKE IT INAPPR=TATE FOR THIS 1ESSAGE TO pE SENT
Awards and National Symbols to Comm fete
Mass?go to be Seat
. ........................ . ......-....._..---•-- •, -_._. ..Si tuts Dana
®Ro-25, FEB, 2010: 12:29 ROS BATES MP - 07) 55690675n TO.MUDGEERABA PREMIER -DE-PT MrII
} Department of the Prime Minister and Cabinet
ENO, 3260 PP. 51 --
Request for Congratulatory Message
To FromAwards end NationalSymbols Brunch MARGARET MAY MPDepwrnent of the Prime
tFEDERAL MEMBER FOR MCPHERSON
er and Cabine- 1046 GOLD COAST HIGHWAYN-35tionalna Circuit PALM BEACH 0 4221A
BA 2600RYON ACT
Ph (02) 6271 5670Fax (02) 6271 5662
(07) 5626 0689 Jnj!(07) 5526 0477
C.^L
copgratt1latory.mea9ages (a3Prnc-ov,au
Noun 1ee^s) Mr Warren end Mn, Noelene Well-1von
include ritle Mr, Mrs etc)
2 Dcnika CourtNominee(s) Address 1t1UDGrTr,BR.Ai3A QLD 4213
Addres8 for Message As above(ifdiffarentfro)n abovQ)
r^^`^9 E SENTOccasion 50"' Wedding Anniversary
pare of Ann velsary/Bixthday28 August 2009 Date Message should arrive 25 August
Certification bySetator/Member orBO that information ...... . ....... .Amanda Beltort,..__... _ ,,........ 07.107/09..
provided is correct I Amanda SEIM - $1MCtorore oXVcor 5ign91rurc Data
Yes No Type of vesifieadon eg, Birth cerT cate'V'erification o£
AnuiversaryBirthdaya
Marriage Certificate
SightedPlease Tick one Box
PLEASE ADVISE hE AWARDS AND NATIONAL SYMBOLS BRANCH IMMEDIATELY IFCIRCUMSTANCES ARISE WHICH MA IT INAPPROPRIATE FOR TI XS MESSAGE TO BE SENT
Awards and National Symbols to Complete
Me age to be Sent
.......... ...... .....•.......... ----------- ......5t nalurc DQtB
6
iLm,,^^25; FEB, 2010F12: 30 ROS BATES MP - 07) 55690675mP1. -1., TO;MUDGEERABA PREMIER DEPT MCUL;F P
Department of the Prime Minister aid Cabinet
,-°NNNO, 3260 p P. 62- - -
Request for Congratulatory Message
TD FromAwards and Ne ►iorSymbols 'branch MARGARET MAY MPDepartment of the prime FEDERAL MEMBER FOR MCPHERSONMiniste'and Cabinet 7046 GOLD COAST HIGHWAY3-5 NAtional circuit PALM BEACH 0 4221BARTON ACT 2600
Ph (02) 6279 5620Fax (02) 6271602,
(07) 5626 0688(07) 6526 0477
c o n g rat u l a tory .mcma,g es ®p m e.ov,au
Notraittee(s) S Mr Amos and Mrs Barbara May SELJiSy,nolude title Mir, Mrs etc
15 Leicester TerraceMUDGEERABA COLD 4213
Nomb e Cs) Address
Address for Message As above(l^dlfgr^nrfrom above) TO , SENT
Occasion 50th Wedding Anniversary
Date of Anniversary/Birthday 2S Mamb 09 Date Message should arrive ASAP
Ceti cation bySenator/Member orEO that information ................Amanda Belzon.......... .......... Date 15/05/09 ........provided is cozzect Nn11AAd5 }301912 - lr1eelut11e0jYjeeC5;iZnpl4[0
Yes No Type of verifoataon eg, Binh certificateVerification of
AnniversaryBirthdayT--`--
Marriage CertificateQ
Sighted(Please Tick oue Box)
PLEASE ADVISE THE AWARDS AND NATIONAL SYMBOLS BRANCH IMMEDIATELY IFCIRCUMSTANCES ARISE WHICH MAKE IT INAPPROPRIATE FOR THIS MESSAGE TO BE SENT
r
Awards and National Symbols to Complete
Message to be Sent
................... /.,.•+.. 1,.._. u. I. - I. r .., .,,,... h.......,.\ h,..------•-------._..... ^.-
5igng"ec
ROS BATES MP - 07)55690675 rr.e1RNNO, 3260' P P. '"I"T --
° ,,fAU DGEERABA PREMIER DEPT MCUFrom
^„ a^icnalMARGARET MAY MP
o'rit Ltb° prime FEDERAL MEMBER FOR MCPHERSONb►nes
^iilf Cl1045 GOLD COAST HIGHWAY
oON
rc2600
PALM BEACH 0 4221>^!• rkY ,
0) 6 71 5620
r(07 ) 6525 0688 61
61 156,62 (07) 5525 0477; it(^Xcaryja 1e$SagesQ pmc.
'fo^',14nl ^e
( )Mlr,MrsEtc)
Mrs Gladys Sands
5 Bresana Courba Qld 4213M dge au
^*iop^lnee() Address
^` r1ddF>w5,s r Ma.sagc As above^-e r om ph(We)
cc ion 90"' 9uthday
ate o `versary/Birthday 2 Februrary 2010 Date Message :should arrive 29 January 2010
'icy, 'on by
e^^tor^ eIflber orx EOlthat^i fo^r,a on ......................Amanda Belton.,,........,......... Date 28/LJ2010 _..... , _.
ruvhdej is correct Aawada8';uon-Ei^^ontcAffoRSi^nan,ra
Yes No Type of vet fication ez. Birth certificate1 cd
,Ilf-,,^^ Arital'^^ e" '
Is
cation ofz qrylBirthday Stajutory DeclaraCioh
. .i'
i heed(Plc2gcy
-
3' ck one Box)
` Ta^ASE ADVISE THE AWARDS AND NATIONAL SYMBOLS BRANCH IMMEDIATELY IFxs- C1RUICS`
STANCES ARISE WHICH MAKE IT 1.NAPPROPRIATE FOR THIS MESSAGE TO BE SENT
tl
- ^, ards an d National Symbols to Complete
®,tiv ra be Sent
Si PaNre IYta
25. FEB. 2010° 12:30
25, FEB, 201012:30 ROS BATES MP - 07)55690675L1i`y" .. GVV^ I J1 V U
'`..,1 i f 6UP . .., ...
TO;MUDGEERABA . IOEMIER DEPT MCU
TO BF S®
Requestfor^a',Congratulatory LetterFull name of persot(fco Ciple cerebrating birthday/anniversary
Please Rjck.appropriate 'dtle C Mr & Mrs Q Mr (prMrs Q MS Q Miss O Dr
V EbA. -9 Y 1p, F0firsrname lasrnamrr
/rrsrname lasrname
ResidahtialaddressI^aoM 1^i L-^1LL• VICt^l1 ^-^ot^S^ _
Address For message (if different from resldenridl address)
Anniversary/birth day
Wedding
Birthday
varific rJon provided
'Wed
TIrthc iV
NNO. 3260 PP. 81 1
Queensland Government
C/
1t1r Acmlor •.no r,E1nLl
posreode
posccode
Q 5o years C) CQ ye'a'rs Q G5 years C 7b years 0 Qfher _ _ years
0 90 years 0100 years Other years
Q Marriage certrficate 5tatutgry declaration (:) Other
® aireh Certificate O statutory declaration 0 Other
Date of anniversary/birthday 5 o q DV to message preferrcpdGfregy lied earlier)
^---IContact details (person makingrequesO
T 0 03 ) TTY-1L,---Z 3 ^S X7'7 Rlelephwpe
address -bq ice/. 4^! u-s/J e CO Rwemail
Certification by Stare Member of Parliament Clfsubmitted through their office)
The original ver7fiMjon document indicated above has been sighted. A coppis attached vii this form-
Date -^ / © l
(Memberfor ( n ,,^t}1)
OFFICE USE ONLYThis form has been forwarded to the followi,s offices;
Q State Member q Electorate Office Received0 Government House Q Prime Minister
rZ d ON 0:b1 6002 'add'LZ
25. FEE; 2010.12: 31x ROS BATES MP - 07)55690675'n_n'_- :_^^ .^. IER DEPT MCURP EM M'
PRENNO. 3260PTP P, 91601/002
M j-E Depax-anent of we Prime urrster and Cabjaet® F1
M Its- Request for Congratulatory Message
To From lt. 1y:Lar►S1v^i y.^ a
Awards and NatiomlS)anbols Bk-finch MARGARET MAY MPDeparrmelt of the primeMi.nisteraud Cabinot L ! Q i^FEDERAL MEMBER FOR IVICPHERSON
3 -5 National Circuit 1045 GOLD COAST HIGHWAY /+C$ARToNACT 2600 PALM BEACH a 4221
(02) 6271 5620 (07) 5525 077F2x (02) 62715662
^^ ^(07) 5525 0
44.77 Q ,^JQ rLl,
Lcongzawlalory,mcssages@pme,^^
JI cov au
Mr Raymond George & Mrs t1ma J'tkrta 91voliff'IV6171j^Ce^S^ ,
inclz de title.ZMIr, Mrs etc -5 Gordonia DriveKGzIgsmore Est
Nominee(s) Address .REEDY CREEK QLD 4227
Address for MesSSge As above((f dEcrr nt from above)
Occasion 50" Wedding Anniversary
Date of Anniversary/Eiday 03 October 2009 Date Message shoed salve 01 October 2009
Certification bySenator/Member orEO that information ....................... mtmdaEelton ....... .............. Date 16/07/2009
provided is correctAlnainla $chon - Etectol^rs OThcc S ehue
yes No Type of vc ification eg. Birth cenjEcateVerifZCaion of
ADniver5ary/Bizthda `,r' q^lszriage Certificate ®(^
szphtedPlease Tick one Box )
PLEASE AI VISE THE AWARDS AND NATXONAL SYMBOLS BRANCH IMMEDIATELY IfCU CUMSTANCES ARISE WHICI1 MAKE IT t APPROPRIATE FOR THIS 1vILSSAGE TO BE SENT
Awards and National Symbols to Complete
Message to be Sent
/ ..........---.,....,....... ......./......-....,^......... ..,,.,,^^^----------------------------SiKnatUie pste
25, FEB. 2010 12:31 ROS BATES MP - 07) 55690675TO:MUDGEERABA PREMIER DEPT MCU
Ja.. , Department of the Prime Minister and Cabinetnn
O. 3260 P, P, 10
Request for Congratulatory Message
To FromEiwards and yadenalSymbols Branch MAP-GARET MAY MPDepartment of the PrimeMfnitlar and C16intl
FEDERAL MEMBER FOR MCPHERSON3•SNadcnal Circuit
1045 GOLD COAST HIGHWAYPALM BEACH Q 4221BARTON ACT 2600
Ph (02) 6271 5620 (07) 5525 0688Fax (02) 6271 5662 (07) 5525 0477
congraculatory, rnessage s(apmc.go^.au '
Nomitxee(s) Mn jean Gillespie Roberts(include title Mr, uny etc)
15 Tuekeroo PlaceNominee(s) Address REEDY CREEK 4227
Address for Message As above(I^Q Jat' rn f►'om cbo^e)
9 6 "SENT
Occasion D
Date of Arnivetsary/Birthday 12'October 200.9 Date Message should arrive 12 October 2009
Certification bySenator/Men nber orEO that infonnation .....................Amazda)3e`lton............... ..... Date 10/07/2009provided is correct
I Amanda $e1t^n - EjGnuatar , OPdclr Si nuw^
Yes No Type of vexifieation eg, BYrttt eatti careverification of
AbniversaYy/Birthday q q M ,zia^e Cerrt6aaca ()j^
Sighted(P1oasc Tick one Box
PLEASE ADVISE THE AWARDS AND NATIONAL SYMDOLS BRANCH IMMEDIATELY IFCIRCUMSTANCES ARISE WTItCH MADE IT INAPPROPRIATE FOR THIS MESSAGE TO BE SENT
Awards and National Symbols to Complete
Message to be $ent
/_.------------- ...+ .............v....../...................................................... ^•
zoo/Load ld3U S83II add 4-
L
n
,Hare -r n
;(d^ 60:51 6aoZ 6a/i
n o 25, FEB, 2010 F12:31 ROS BATES MP - 07) 55690675n A JO;MUDGEERABA PREMIER DEPT MCU
n IL?^ 7 Department of the from Minister and Cabinet
W% 9- ^ucxa Lx q ^^
NNO. 3260 p P. 11
Request for Congratulatory Message
To Paotz►Awards and NationalSymbols Bmeb MARGARET MAY MPDepaMienr of The PrimeMiniow pnd Cabloc t
FEDERAL MEMBER FOR MCPHERSOJN1045 GOLD COAST HIGHWAY ^ 43W-S National Circuit
BARTON ACT 2600 PALM BEACH Q a - (.. PC MESSAGE
Ph (02) 6271 X620 (07) 5525 0698 TO BE SENT y1^Fax (02) 6271 502 (07) 5526 0471 1 ©J© C
con^rrasu]atory, cnca:ld{IovLptnc.Sov.9lt
Nominee(s) Mr TRyan and Mt$ Judith, Ryaninclude tike Mr, Mrs etc
11/2 Penda CourtNominee(s) AddTe a NMRRIM,LC QLD 4226
A.ddreNs for Message As above
Occasion. 501' Wedding Anri t'ersary
Date of A,hniversaay/Birthday 30TH October 2009 Date M=op shoWd arriv'o 28 October 2009
Cmtficarrion bySenator/Member orEOthaLinformaMor► ,....,.........AmaTlda Belton_.,__.,....... ,....... Date 21/10/09.,,,,......Lowi ded is correct Amanda 0ellon Glmwr0e O¢iioe; Sigptltue
Y65 No Type of verification eg. Birth, certificateVerification of
Anniversary/Birthday Li Statutory Declaration
F1sightedpicric Tick one Eox)
PLEASE ADVISE THE AWARDS AND NATIONAL S\YM$OLS BRANCH 1MMEIATELY IFCiRCUMSTANCES ARISE wrnci MAKE i T 1NA? ?ROPRxATfl FOR THIS MES SAGE TO BE SENT
11
Awards and National Symbols to Cozapiete,
McCS9%c to be Soill
/
11
............................ -........^....... ._,. ,..,............,-5i2arurs - 4_
25, FEB, 2010 12:31 ROS BATES MP - 07) 55690675 a PREP+NNO, 3260 PP. 1241/bA?TO:MUDGEERABA PREMIER DEPT MCU
Depaztmenr of the Prime Minister and Cabinet
Request for Congratulatory Message-I
To Fz0111
Awax'dSS and Netiohalsymbol, Branch MARGARET MAY MPDqarcmeii ofihe Prirne FEDERAL MEMBER OR MCPHERSONMinister and Cabinet3-5 rational Circuit
1046 GOLD COAST litGHWAY
BAXTON ACT 2600 PALM BEACH Q 4221
Ph (02) 627.1 5620 (07) 525 0688LPa% (02) 6271 566;2 (07) 5525 0477
co>^^zawl^ cory,^^3d a ^t5 (^pma.
Nominee(s) Mrs Muriel Ryaninclude rifle Mr, Mrs 6'1c)
Villa SerenaNominee(s) Address 2 Eastb3,)l Drive
Rob na Qld 4226
Address for Message As above((f df f)erenl ftom shove)
Occasion 100'h B1rrh^ay
Date of AnnivercaryBlrthday6 December 2009 Date Message should arrive 4 December 2009
Certification bySunator/Member orEO That information Amanda Belton Llootorate Officer Margaret May MPprovide i is correct
yes No Type ofvetification 09, Birth certificateVerification of
, nniversary/B rrhday q Statutory Deoltiration
Sighted LJ
(Please Tick one Box)
PLEASE ADVISE THE AWARDS AND NATIONAL SYMBOLS BRANCH IMMEDIATELY IFCIRCUMSTANCES ,ARISE WHIC14 MAKE 17 INAPPROPRIATE FOR THL$ MESSAGE TO BE SENT
Awards and National Symbols to Complete
Message to be Solt
I I
.. ... ....\/111 •.. 11 .............................. 1 V.111.................... .... . ... . . . •. 111\V n....1IIr ..•
Sienntum Date
.k ,&N/25. FEB. 2010512; 321 ROS BATES MP - 07) 55690675.To MUDGEERABA PREMIER DEPT MCU
a DepanmerLL of the Prime Minister and Cabinet0 UK -I.
. for Congratulatory Message
TodN l
From
Awardi an atiqnaSymbols Branch MARGARET MAY MPDapanrnent of the Psime FEDERAL MEMBER FOR MCPHERSONMiniycerand CabinC 1045 GOLD COAST HIGHWAY3$$ Nalim id CirctiR.
M TON ACT2600 PALM BEACH Q 4221 Ga 'C 1^E8SAG,^Ph (02) 6271 5620 ( 07) 5525 0688 TO B NT
(07) 5525 0477f^
Fax (0Z) 62715662congsatu7azpry.meCtiagesmp.
Dv au
Norninec(s) Mr WalterJamea and Mrs Berneice Gracc Robinson(include ritlc Ad Mr's etc)
20 Helpmann CourtNorniiiee(s) Address I Gooding Drive
Merrimac Qid 422(i
Address for Message As above(ifdi&erew fkom above)
Occasion 60111 Wedding Arlniversaly
Date of AnnivelsaryBirthday 10 December 2009 Date Message should ave IO December 2009
-4 1Certification by GUy,^ {Sonalor/Member orEO that information ........ .............. AmodaMelton.,..,..,..,.,....,.,., Date71l0/2009 ...........provided is correct Be1ton - 0staiaie017ieersignmun'
Yes No Type of verification eg_ Birch certificateVerification of
AnniversaryBiTthday Marriage Cersifl qaieF OR,S1gbzcd(Please Tick one Box
PLEASE ADVISE THE AWARDS AND NATIONAL SYMBOLS BRANCH IMMEDIATELY IFCIRCUMSTANCES ARISE WHICH MAKE IT INAPPROPRIATE FOR THIS MESSAGE TO BE SENT
Awards and National Symbols to CQTnplete
Messngo IP be Sort
.............., .......... ... .......^.......................... .1............• 1.1.........a,..
5i6nnhUrC"
._../._.-J.- -•-Dnte
25. FEB. 2010 12:32 EROS BATES MP - 07) 55690675
TO:MUN EERABA PREMIER DEPT MCU
Request for a Congratulatory LetterFult name of person/couple celebrating birthday/anniversary
NNO, 3260®P-P, 14
Queehsland C overnrnehtVRminr^i d GDi
• A G.m
•'3;syid ► il^'T
eolo
Please tick appropriate title Q Mr & Mrs Q Mr Mrs O MS
C R rrf V-r e -ro R iAwstname
frorame
Residentid l address
V
^t^Id Dsor<lasrAOme
Last name
Address for message of diffatent from iesidenrial a"d s
Anniversary/birthday
Wedding
girtFrday
Varrncation provided
Wedding
Birthday
Q 50 years Q 60 years Q 65 years
Vr 90 years Q 100years ()Other_
0 miss Dr
/l 1 r G t: V jc (iVc -
postco0e
posrcode
Q 7o years Q Other years
years
Q Marriage certificate Q Statatorydeclaratiorr
Q' Birth certi fi cate O Statutory declaration
Date of anniversary/birthday _
Contact details (person making request)
Date message preferred(iflaqulrcd earlier)
Q Other
0 other
/C) J -2 61.0
o/lame [ele hone'0
P a Ad lt. 1^ tL1
Certification by State Member of Parliament (W$ubmitted through their office)
The original verification documentindicated above has been sighted.A copy ls attached with this form.
Date
(Memberfor
OFFICE USE ONLYThis form has been forwarded to the following offices:
MP)
q State Member q Electorate Office ReceivedQ GovernmentHoUse Q Prime Minister
J"5. FEB, 2010"12:32''^ ROS BATES MP - 07) 55690615PREMIER DEPT MCUGEERA6RrDtt'
Department of the Prime Minister and Cabinet
-NNO, 3260--P P, 15._Phcrnl.eKS DEPT ® 007/002
Request for Congratulatory Message
A-atdt` and NationalSymbol ;ti, BranchDeparunent of the pri ne
From
MARGARET MAY MP=CnUO Al ML--r+A=CC I
" 3; BE SENTtmstc, an a mex
3--5 National CirL'IJIt
BARTON AT 1600
1045 GOLD COAST HIGHWAYPALM BEACH Q 4229
Ph (02) 6271 5620F 02 2'715 62
(07) 5525 068807 5525 0477 CAx ( ) 6 6
a6F^^aL1^^to^•^^^,SLi^O^^^,IDC.
( ) ^(1^r1/n^i„_/I ^7 f ffe^li ,/{^
r ►^ `l ^^usu
., Mr John Walter and Mrs Kathleen Patricia Turd ey1
m h (S)tw'r``>rx ,finelude title gy, Mrs etc)
761 1 Ridgevisfa Court
iReedy Creek Qld 4227
; Nominee(s) Address
,ddTesg for Message As above=fn.,,(f^lff^yrenlfrom uho.'eJ
3r" ",'Occa§ion 50'h Wedding Annivergary
n /'Fate of:A,tuxivorsarY/BirrhdaY 28 November Date Message should rive ] 9 November
Certffl cation byu" '^SenaGoxlMober or
that information . manda Beican .. ........... WI... Date 16110/2009. . . . . .provided is correct
,.... . ... .. ... ..A..,
^i5.^'... Ammt ^71 Fulton ^ FlcctoraFa O^jltcT Si GNre
yes No Type ofverifieadoxa eg Birth cerdfbate. , erifioalson of
;Anniversary/Birthday Marriage CertificaWe f'1x F^7^Ced;.„d.(P1ea.Se^i ick one Box)
PLEASE ADVISE TITS AWARDS AND NATIONAL SYMBOLS BRANCH TMMED)ATELY IFCIRCUMSTANCES ARISE WHICH MAKE IT INAPPROPRIATE POR THIS MESSAGE TO ^E SENT
^wards and National S bols tto Co m lots
lke',T ge to be Sent
J I ....1/I . I.,^IA r......... r..........11^, . ar.1.,......1 .....................I .r ... 1.1......1.... •....N .\..n^4 ......
sienllura
CLS.' {J. ` ' ' '
,fERABA PREMIER DEPT mCUDepartment of the Prude Minister and Cabinet
+ FKK „ 00. 3260" PP. 16'0 1 r' `;z
Request for Congratulatory Message
0
FEB. 20101412;33; ROS BATES MP - 07)55690675
To FromAwara9 and National
Symbols Branch MARGARET MAY MPDeparim em of the Prime FEDERAL MEMBER FOR M CPHERSONMinisctr aad Cabinet 1046 GOLD COAST HIGHWAY3•S N-Itional Circuit PALM BEACH Q 4221BARTON ACT 2600
Ph (02) 6271 $620 (07) 5525 0686Fax (02) 6271 5662 (07) 5525 0471
congttltul=ryrmesas gas@ptno.
poy.au
Nominee(s) Mr Douglas Gerald and Nils Nola June Guntoninclude Ode Mr, Mrs etc
15 Canopy DriveNominee(s) Address BONOGIN QLD 4213
As above
Occasion 6& Wedding Anniversary
Date of AnniversaryTBirth day3 September 2009 Date Message should arrive 3 September 2009
Certification bySen tor/Member orEO that inforrnatio i AniandDate 11/08/2009
rovided is crrect
No Type ofverification eg. Birth certifcate
Ver cat°fon ofVCrsary/Brthday
-
F-1 I Marriag Getifirte
S}gb,°ted(Please Tick one Box
PLEASE ADVISE THE AWARDS AND NATIONAL SYMBOLS BRANC141MMEDIATELY ITCTRCUMSTANC1=S ARISE WRICH MAKE IT INAPPROPRIATE FOR TI-ITS MESSAGE TO BE SENT
Awards and National Symbols to Complete
Message to be Sent
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TO BE SENT271 &109
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Mudgeeraba Electorate Office
From:Sent:To:Subject:
Burleigh Electorate OfficeMonday, 22 June 2009 5:47 PMMudgeeraba Electorate OfficeCongratulatory Letter
Attachments : Picture (Metafile)
Good morning MudgeerabaWe had a call today from a lady (Norma) to tell me that Mr Tom and Mrs borothy Forrest,of 4/46 Woodland Drive, Reedy Creek, are celebrating their 65th wedding anniversary an
Wednesday!
I explained it was too late to organise congratulatory letters (and she said they didn't wanta fuss) but I thought RoS may like to acknowledge the event.
Warm regards,Christine
Christine Smith MPMember for BurleighPO Box 172MIAMI Q 4220
Tele: 07 5526 6024Fax: 07 5526 6135
Tnm rr ,, Q a,d-- l
Have your say about Tomorrow's Queensland: httip://VNM.tc)wardq2.cild.gov.au/tomorrow/
1
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25. FEB. 2010,112:33azaa7 IROS BATES MP - 07) 5569D675^cFAR xB MpO,MUD MABA PREMIER DEPT MCU32147
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' Request fox Congratulatory Message
NO. 326050P, 1 B 2 /0o3
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^" SACEN1it1sr r and Cabinet3-5 National Circuit
27 6 Margaret St "(P0)3ox777) BE SENT
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Date wessgiae tb
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T^qXO nes42►ge to be forwarded.
25 . FEB. 2010 12:33 ROS BATES MP - 07) 55690675 N0, 3200 P. 19P 1
COMMUNICATION RESULT REPORT ( 25.AUG.2009 16.32 ) * *
FAX HEADER 1 ; ROS BATES MP - 07)55690675FAX HEADER 2;
WSMITTED/STORED : 25.AUG.2009 16:31ILE MODE OPTION ADDRESS RESULT PAGE-------------------------------------------------------------------------------------- ------------
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/4 fR/A/yl 0 Rflistname lastname
fir name (art name
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(Member for .)
OFFICE USE ONLY
This form has been forwarded io the following Qfficesz
53' rot f l,6
U StatQ Member Q Electorate Office Receivedq Government HoUSQ q Prime Minister
25 , FEB. 2010 12:34 ROS BATES MP - 07) 55690675PREMIER DEPT MCU
firs! name
Queensland GovernmentDeperurcnt gt'she PlvaicaM abNt
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lasrnama
ly^st name
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The original verification document indicated above has been sighted- A copy is attached wit,,this farm.
Date
QfFitE USE ONLYThis f rm has been forwarded to the following offices:
>te Member r-,rovernmertt House
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n 25.FEB. 2010 12: 34 ROS BATES MP - 07)55690675myMMIJDGEERABA PREMIER DEPT MCUFEE
neQueensland GovemmentDBpaament of M4 P><niicr 2nd WincL
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WQJ tLfirst name
(no-Ffirstn me
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hate
rate member rY1Government HouseR
-z'f-411 09 9.,-", ^ O^' ^ ^R06 ga-f^,s , MP)(Memberfor
OFHCE USE ONLYThis form has been forwarded To the following offices;
^] F,)ettorate Office Received1rime Minister
TO BE SENT;Zql -7/0
A i'%25. FEB. 2010912; 347 ROS BATES MP - 07) 55690675IN ff5 TO;MUDGEERABA PREMIER DEPT MCU0
M ^ it 1 Depatttllerie of the Prime Minister and Cabinet
PREMNO; 3260PT P. j/22 101/002
Request for Congratulatory Message
To FromtAwards and Naional
5ymbo,lg BraxcL
MARGARET MAY MPDepanmenr oftha Prime
tand C krFEDERAL MEMBER FOR MCPHEASON
5 Sm ujj3S3 National Circuit
1045 GOLD COAST HIGHWAY
BARTON ACT 2600 PALM BEACH Q 4221 ° "-
Ph (02) 6271 5620 (07) 5525 0658 BE SENTFaX (02) 62-715662 (07) 5525 0477
congQM]atory.MassagesQa pn .oy,au
Nominee(s) Mx' Barry Fergt3son and Mrs Lorraine Ferguson(include tine Mr, Mrs etc
32 Kerrigan CourtMUDGEEi2ABA QLD 4213
Nominee(s) Address
Address for Message As above(fd feranrfrom above)
Occasion 60`6 Wedding Arinivetssry
Date of Anniversasy/Bivhday7 May 2009 Date Message should arrive 7 May 2009
Certification bySenator/Member prBO that information .....................Amandaprovided is correct AYnandu NcI{on Pleclorace OEFicec 5i^ndlls DSr
Yes No Type of vedfication eg, Birtb certificateVerification of
Aug iverSary/Birthday q Mazx c Cettificate
Sightedl --I
(Please Tick one Box
PLgASE ADVISE THE AWARDS OD NATIONAL SYMBOLS BRANCH IMMEDIATELY IFCIRCUMSTANCES ARISE WHICH MAKE IT INAPPROPBIAT$ FOR THIS MESSAGE TO BE SENT
Awards and National Symbols to Complete
Message tv be sent
I .....................,.. _ .... ...... . .. .........,........... . ...... ,,....... .....J....... 1...,.,Si luil Date
rrctru ^25, FEB. 2010)'12;351 ROS BATES MP - 07)55690675 INO, 3260 ' }P, 23TO:MUDGEERABA PREMIER DEPT MCU
,',,NA B LT11 °
DeparLu ent of the Prime Minister and Cabinet
xequest for Congratulatory Messageal
T From
Awards =dNationalSymbols Branch MARGARET MAY MPDepa=cnt of the Prime FEDERAL MEMBER FOR MCPHERSON--•---'-`Minister and Cabinct3-5 Nai onal Circ%xU
7 045 GOLD COAST HIGHWAY
BARTON ACT 2600PALM BEACH 0 4221
i` SENTti uL
5 0688 s-16507Ph (02) 6271 5620 ) 2(Fax (02) 62715662 (07) 5625 0477
CO neat [email protected],au
Nominee(s) Mrs Lilian May FalwasserLneh ide title Mr, Mrs etc
Villa SerenaZ. Easi!hilll Drive
Nominee(s) Address ROBINA QLD 4226
Mrs Lilian. May Falwasserc/o 69/12 Commodore Drive
Address for M eysage SURFERS PARADISE QLD(if d jerenrfro)n above)
Occasion 100U' Birthday
Date of Az n versaty/Birrhday -8 May 2009 Dato Message should arrive 28 May 2009
Certification bySenator/Member orE0 that ,information ........I ............Amajida Date
provided is corrc Annad3 130(on-r-1wW or xr S 1g,8NIe
Yes No Type ofverifcation. eg. Birth cerdf caw
Verification ofAra^versarylBirrhday x q Birth Certificate
SightedP ease Tick or,e Box
PLEASE ADVISE THE AWARDS AND NATIONAL SYMBOLS 13RANCH IMMEDIATELY IFCIRCUMSTANCES ARISE WHICH MAKE IT INAPPROPRIATE FOR THIS MESSAGE TO BE SENT
Awards ax1,d National Symbols to Complete
Message to be $cot
........111........... ,..- . ......................................... ..........• ..............
Si tie
J525. FEB, 2010' 12:35" ROS BATES MP - 07) 55690675 i PAENNO, 3260PTP P, 24ou1 002u:FiiuuuttnA15 H 1ror;ntiviitrc utri ii u
® Ards and Nationald^ymbals Brynah / "
MARGARET MAY MP ' vDepartrnentoEthePrime !^oM^sternndCabinet
FEDERAL MEMBER FOR MCPHERSON7045 GOLD COAST HIGHWAY; -5 National Circuit
BARTON ACT 26QQ PALM BEACH Q 4221
Ph (02) 62715620 (07) 5525 0688Fax (02) 6271 5662 (07) 5525 0477
sonaraciilawry.saes^aS¢,y t^mc,,ov.au
Nox row(s) Mrs Rose Lilian Fair homeinclude title Mr, Mrs crc
3 Exbridge CourtMUDGEEB BA QLD 4213
Nominee(s) Address
Address for Message As above(idi ffL7ent from gbuvc?)
OccaSiorl 90`h Birthday "
-)ate of Anniversary/Birthday7 September 2009 Date Message should arrive ASAP
Certification bySenator/Member orEO that information ........._ ^.,.__......^nand Belton,.... ................ Date 31/08/09........_..provided is correct Atnand^6du>n Eleclor5it0 (ilcer^i^h3Wrc
Yes No Type of verification eg, Birth certificate
verification ofAtuivarsary/Birthday Birz]^ C^z f3^^
SightedI ,
(Please Tick one Box
PLEASE ADVISE THE AWARDS AND NATIONAL SYMBOLS BRANCH IMMEDIATELY IFCIRCUMSTANCES ARISE WHICU MAKE IT WAPPR.OPRTATE FOR THIS MESSAGE TO BE SENT
Awards and National Symbols to Com fete
Mes&age to be Scnt
............ .... ......... ........,....,...,,,,....,,_.,...... ../„,.,./.,,..................... ...... .dli^has►Pe °' Daze
FED ROB BATES MP - 01)556906752010 12 355 I ;;,2 )yII
Departmer of the Prime Miaiater and Cabinet
PNQ, 3260.Ee FP. 2^----^^a
Request for Congratulatory Message
To FromAwards and Natxon idSymbol; Brancf) MARGARET MAY MPDepanment of the Prime FEDERAL MEMBER POR MCPHERSONMitxister and CabineE.,-5 Natioml Cireail 1046 GOLD COAST HIGHWAY
BARTON ,4\c1 ' 2dob PALM BEACH Q 4221tf'C MESSAGE
Ph (02) 6271 5620 ( 07) 5525 0658 TO BE SENTFax (02) 66271 5662 (07) 5525 0477
eongrant1otoi me,tia^e^([rvpa^e,ov.=
Nominee(s) Lily Ethel Drury(include ride Mr, Mns erc
13 Cedarwood CrescentNominee(s) Address Robing Qld 4226
Address for Message As above( ►rdi7are7u role ahovu')
Occasion 99i1' BjTthday
Dace of Ax iversary/Birthday 26 November 2009 Date Menage should arrive 26 November 2009
Cerdlication by$ natcr/Member orEO thatinformacion ....^,,, ,,,,AnlarldaBelton ....... .,......-....., Dare 27/10/09-.-.,......
rovided is carrcct Amnda Salton - F1c,:towc ol2icuz sigmmro
Yes No Type ofei icetioii eg- Birth certificate
Vorification ofAnniversa3/Ir3irth.day
^--^drib Cgrtlficate
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PLEASE ADVESE THE AWARDS AND NATIONAL SYMBOLS BRANCH IMMEDIATELY IFCIRCUMSTANCES ARISE WHICH MAKE IT INAPP OPRlATE FOR TRXS MESSAGE TO EE SENT
Awards and National S bogs to Complete
Message to bu Sent
/ / ................ I............ ^,._..,......., .......... .,..-...------- ,.......... ,,^,.. ^.,,../,,...../....,.sigmium Date
25. FEB. 2010) 12:36) ROS BATES MP - 07) 55690675 fNO, 3260 FP226
To,MUDGEERABA- PREMIER DEPT MCU11,L.lf1,4 o r a C®n^rdl,ula>:ory LetterFull name of per5onlcouplE celebrating birthday/anniversary
Please tltk appropriate title 0 Mr & Mrs 0 Mr Q Mrs O Ms 0 Miss (0 Dr
first name last name
first name lost name
Residential addr ss
A d d re5s for mess age (if dlfferenr from residential address)
Anniversary/birthday
Verification provided
IFINON -(
O po years O 10o years er9/ years
Qast4vda
pas¢ode
0 50 years Q 60 years 0 65 years 0 70 years 0 Dther,___year5
O Marriage cartiiicare 0 Statutorydeclaration C Other
O 8irrh certificate 0 Statutory declaration Other
Date of anniversary/birthday (0 Date message preferred(Ifrequired earrlet)
Contact details (person making request)
name
address
ielephpne
enroll
Certification by State Member of Parliament (ifsubmltted through the1roffice)
The original verification document indicated above has bean sighted.A copy is artached with this form.
Dale
(Member for
OFFICE USE ONLYThis form has been forwarded to the following offic=s:
q State Member q Electorate Office Race ivedq Government House C) Prime Minister
MP)
iV5, FEB. 2010)412, 36, ROS BATES MP - 07) 55690675ro- PREMIER DEPT MCU
Deparmzent of the Prime Minister and Cabinet
PNO, 3260 FP, 27^
Request for Congratulatory Message
To FromAwards aild r1'ationai
Symbols Branch MARGARET MAY MPDeparcmrr,t of the Mme FEDERAL MEMBER FOR MCPHERSONMinister a id Cabiftet 1045 GOLD COAST HIGHWAY ..
45-5 Narional Circuit13A1iTOt4 ACT 2600
PALM BEACH Q 4221 $ ^. is lei 1...
TO BE ^`'Ph (02) 6271 5630
Fax (02) 6271 5662
( 07) 5525 0688(07) 5525 0477
ccn ^'aculaCOry_tn@ssa ga s @p tm c.ov.au
Cox Mr Anthony Charles and Mrs Patricia ArneNortiinee(s)
(^tclude title Mr, Mrs etc
295 Gold Coast- Springbrook PdNomin4e(s) Address MUDGEERABA QLD 4213
Address for Message As above( fdiffero irfrom aboya)
Occasion 50th Wedding Aruiiversary
Date of AnnjVersar) B3rrhday 13 June 2009 Date Message should arrive I I Juixe 2009
Certification bySenator/Member orEO that infozmation ......................Amanda 13 elto)a ...................... Date 14/05/09_..._ ...
provided is correct ptnanclaBehon0Eloctordteo rit_ignztare
Yes No Type ofverifieatio. eg. Binh certificateVerification of
Anniversary/Birthday Marriage Certificate
Sighted(Please Tick one Box) LK
PLEASE ADVISE THE AWAYZDS AND NATIONAL SYMBOLS BR^NCI, 4&N-lY IFCIRCUMSTANCES ARISE WI-TTC . MAKE TT 1NAPFROFRIpTE FOR THIS MESSAGE TO J3E Sl
Awards and National Symbols to Complete
Mesa ge to be Sent
.......... ....... ......... .............. ....5enature
1,575
--l/ .... . .1--pate
`125. FEB, 2010 12:36 ROS BATES MP - 01) 55690615 0. 3260 P. 28P.
.' x COMMUNICATION RESULT REPORT ( 29,APR.2009 13:57)
FAX HEADER 1: ROS BATES MP 07)55490675FAX HEADER 2:
RANSMITTED/STORED : 29. APR. 2009 13:56ILE MODE OPTION ADDRESS RESULT PAGE
------------------------------------------------------•--------------------------------749 MEMORY TX 63 :PREMIER DEPT MCU OK 3/3
REASON FOR ERRORr-i) I•IANa UP OR LFNE FAIL E-2) BUSYE-`_)) NO ANSWER E-4 ) NO PACUIMILE CONNECTIONE-S MAIL, SIZE OVER
Queensland GovernmentDepvrtmcnk of 4r1 Pmprav and LabIng5
Request for a Congratulatory LetterFull nameor person /couple cetebretin - bt day/anniversary
Please tick a propriate title Mr & Mrs Q Mr Q Mrs Q Ms C Miss 0 Dr
first name%^i-RO CQn/S oL
last name
ryrscnamc
Resldontiet address
last ndmc
Address for message (If differenr/rom reside nrla1 41 ddrass)
postcgde
Anniversa ry/birthday
Wedding
Birthday it
Verification provided
ears 0 60 years C 65 years Q 70 years. Q other
Q 9I1 nears Q zb0 years Qdther years
VMarriage ce1'tificate 0 Statutory ddctaration C) Other
Q Eirth ccrti (5cate 0 Statutoryde-claraxlofl Q Qther
Wedding
Birthday
Data ofanniverAAry/birth'day ®_ 4// 020 0 Date message preferred-7 - elfrequlre4(orher)
years
Coritactdetails (person makingreg4e5O
Hams4
- - - telephoAa -
'bddress ' i ' --. _ -
- - -- - email -
Certification by State Member of Parliament (if submitted through their office)
The original verification document indicated above has been sightdd. A copy is attached with this form.
Date - I/ ,r%am- , MP)
O emberfor •MV ^E.Q!ri¢^A )
OFFICE USE ONLYThis form has been forwarded to the following pfficasi
Q State Member Electorate Office ResolvedQ Government House 0 Prime Minister
25, FEB. 2010)'12:36, ROS BATES MP - 07) 55600675TO:MUDGEERABA PREMIER DEPT MCU
,,^, Department of the Prime Minister and Cabinet5
NO. 3260 P
Request for Congratulatory Message
To FlomA 'arils and NationalS b 13 h18ym o , rarJc MARGARET MAY MPDeparvnent of Cho Prime FEDERAL MEMBER FOR MCPHERSONMinieierand Cabinet 9045 GOLD COAST HIG HWAY3-5BA TONNational
ACTcirouit260
BAI^TON ACT 2600 PALM BEACH Q 4221'^ °° ••
CY•. .
e l:Ph (02) 6271 5620 (07) 5525 0680 ,, 0 BE ,Fax (02) 6271 5662
congrawlarory^messages ter pmt,(07) $625 041Y
cj,^^l ^f
gov,avjMr K0ith and Mrs Doris Blake
Nom ce(s)
^^(^ /j0
'%*)11include title M, Mrs etc , t
Unit 147Nominee(s) Address 53 Old Coach Road
MUDGEERABA QLD 4213
Address for Message As above(if d4ffereufrorn above)
Occasion 60`x' Wedding Anniversary
Date of Axniversary/Birtb.day24 September 2001) Date Message should arrive 18 September 2009
Cerdfjcation bySeraatorIMember orEO that information ....... . .....Amanda Belton .. .... .._.....____.... Date 7/07/2009 ..........
provided is correctAmanda l3o)Ian - Eleo ►otatc Oi iccr $ ignatur;
Yes No Type of verification eg. Birth ceztificateVerification of
Anniversary/Birthday x q Marriage Ce ti icat^ r/^
Sighted UPlease Tick one Box
PLEASE ADVISE THE AWARDS AND NATIONAL SYMBOLS BRANCH IMMEDIATELY IFCIRCUMSTANCES ARISE WHIG MAKE IT INAPPROPRIATE FOX THIS MESSAGE TO BE SENT
Awards and National Symbols to Complete
MessAge to bo Sent
/ I I. ...........................................................................
5muie
5, FEB, 2010 12:37 ROS BATES MP - 07) 55690675 0, 3260 P, 30 P.
x COMMUNICATION RESULT REPORT ( 1. JUL. 2009 10:10 ) * * x
FAX HEADER 1: ROS BATES MP - 07)55690675FAX HEADER 2:
A N5MITTED/STORED : 1. JUL. 2009 10:09tlt^ MODE OPTION ADDRESS RESULT PAGE----------------------------------------------------------------------------------------------------g94 MEMORY TX G3 :PREMIER DEPT MCU OK 1/1------------------------------------------------------------------------------------------------
REASON FOR ERRORE-I
))))HANG UP OR LINE FAIL
e -) M AILN@i,ZE OVER
E-2; 64evE-4 NO FACSIMILE CONNECTION
Queensland Governmentoeportmen [ o r the rremter and c hint
P eese tick appropriate title Mr 14 Mrs Q Mr
Request for a Congratulatory LetterFull name of person f couple cetebroting bi hday/anniversary
r
Residentialress
postcode
0 Dr
S re U.R- 6?r/a , .
Address form essage pf drff rent f?om rasidentlal address)
ovar
Anniversary/ birthday
Wedding
Birchday
Verification provided
poweade
0 50 years J50 years O 6^ years Q 70 years Q Other_ years
Q Poyears 0,10Qyears Qother yed-r5.
i (Marri71ge certificate 0 $taturoTydeclaration Q. l7theeWedding
Pirthdav Bluth certificate 0 Statutorydeclaration 0 other
/ Date message preferredDate ofanniversaryfbirthday 10242(f'raquIr d earner)
Certification by State Member of Parliament (if submitted through their office)
The original verification document indicated above has been sighted. A copy is attached with this form.
addressO^ /^^P &-10 rSE f" 34/ OO.rd C 0fl t - ^ `'f
f nieil
Conte details (person makin
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t a wl 1-P- f-s,^yname
/ ^^L r^ t t`^'^ 4>-"41 u [,r one ) 9h
p ate P?96 IQOC.^MP)
(Member for
OFFICE USE ONLYThis form has been forwarded to the following off-icEs:
q State Memberq Government House
q Electorate Office Receivedq Prime Minister
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25 , FEB, 2010 12:37 ROS BATES MP - 07) 55690675 NO, 3260 P, 31P. I
COMMUNICATION RESULT REPORT ( 15.FEB.2010 12:09 ) * * --
FAX HEADER 1: ROS BATES MP - 07)55690675FAX HEADER 2:
kAlSMJTTED/STORED : 15, FEB. 2010 12:08[,LE MODE OPTION ADDRESS RESULT PAGE,. -,--W----------------------------------------------------------------------------------------------
0 MEMORY TX 03 : PREMIER DEPT MCU OK 3/3L3- ----------..,,-----------------------------------------•---••----..-------_,..-.,------------°--..--.-__--
F rEasgN FOR ERRORE-r MAN G UP OR LINE PA = L E-2; BUSYE-8 NO ANawER E-4 NO FACUIMILE CONNECTION
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Q Mr
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Ann iversary/birthday
Wedding
Birthany
Verification provided
Wedding
Birthday
paskods
postcode
$oy:4ars Q 6bye?;Cs Q 65 y04r5 070.ye1rs 0 Other yedro
Q 96 years Q,10 Years ;.QOtt;r years
arffage certificate Q Statutoryy declaration Q ocherQ 13ith CerflQrate Q Statutory declaration 0 gther
bate of anniversary/buti#Idap/^/off,®^ O Date mes ,sagc preferred(ifrequlrad oarlier)
Contact details (parson molting request)
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ema F
releplione
Cortiticatiorf by State Member of ParUa ment (if submfitted through their office)
The original verllcation document Indicated above has been sighted. A copy is attached with this form.
Date / lr t
(Merrrber For
OFFICE USE ONLYThis fom, has been forwarded to the following offices:
q State Mernber q Electorate Office ReceivedQ Government House q Prime Minister
Oueehsland Government=gnt7-.h. Pmmrer pnd moine;
Q Mrs Q Ms 0 Miss Q Dr
last rhyme
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670QueenslandGovernment
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ROS BATES MP - 07)55690675PREMIER DEPT MCU
ENO, 3260 1P. 321
Request for CongratrzlatoryLetter(Sep' Con,-ratulatoryLetrer Infozmation Sheetfor,import nt addttloztal. rrtformation)
Q 65 Years
® 00 Yeats
Q Other : .................... Years
Other; ......_. ...............
NAME;ADDRESS;
EMAIL:PHONE:
0 BiNr Cet cate
q Statutory Declaration
q Other: ...... ...........
Mie verification doaurrent indicated above has been sighted . The anrdversary and the data shoWnabove are correct.