31
25, FEB. 2010 12:29 ROS BATES MP - 07)55690675 O. 3260. P. 2 Queensland Government Dnpanment or the PMmk and Cnbid4t Request for a Congratulatory Letter FUJI 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 addres O last nomil bast name postcode Address 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 D ate of anniversary /birthday ^^rl q ^ 9 Date message preferred fifrequfrsd earlier) l 5 %o & y z 7 Contact details (person mahi'ng raquast) name ra! h n ^ _ - tc t rg. email 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 ONLY This rorm has been forwarded to the following offices: O State Member O Electorate Office Received q Government House Q Prime Minister ,MP) L13/..O 3ZIS lives 6 5-3 NOII3BNNOO 3l IWISn wJ ON ((b -B >l5n1SNW ON L-3 ABno ( L3 -li v id 3Nr'1 210 drl ON^dN -3 JOU89 'dOd NOev521 ------------------------------------------------------------------------------ ------- E,/c ^0 fl)W 1d30 H3Ii Hd E9 X1 AJOVJ LS( --------------------------------------------------------------------------------------------------- 3EJVd 11fS3H SS3HaV NO11dO 30OW 31: ^Z!SG 6O0Z I 'OE : 03HOIS/a3llJWSN'd1 :Z b10V?H Xdj SL906955(LD - dW S31d8 SOa :t d3aV3H XVj * z (SZIEt 600Z'1flf"OE ) lNd3a 11fS3?i N011V0INfWW00 'd

Request for a Congratulatory Letter - Queensland Parliament€¦ · Request for a Congratulatory Letter full name of person/couple celebrating b' hday f anniversary Please tick appropriate

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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.

email

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)

L13/..O 3ZIS lives 65-3NOII3BNNOO 3l IWISn wJ ON ((b -B >l5n1SNW ON L-3

ABno (L3 -li v id 3Nr'1 210 drl ON^dN -3JOU89 'dOd NOev521

-------------------------------------------------------------------------------------

E,/c ^0 fl)W 1d30 H3Ii Hd E9 X1 AJOVJ LS(---------------------------------------------------------------------------------------------------

3EJVd 11fS3H SS3HaV NO11dO 30OW 31:^Z!SG 6O0Z I 'OE : 03HOIS/a3llJWSN'd1

:Z b10V?H XdjSL906955(LD - dW S31d8 SOa :t d3aV3H XVj

* z (SZIEt 600Z'1flf"OE ) lNd3a 11fS3?i N011V0INfWW00

'd

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

email

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

email

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

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iReedy Creek Qld 4227

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FEB. 20101412;33; ROS BATES MP - 07)55690675

To FromAwara9 and National

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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

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Ver cat°fon ofVCrsary/Brthday

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PLEASE ADVISE THE AWARDS AND NATIONAL SYMBOLS BRANC141MMEDIATELY ITCTRCUMSTANC1=S ARISE WRICH MAKE IT INAPPROPRIATE FOR TI-ITS MESSAGE TO BE SENT

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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

Ll 'd 0923 'ON SL9069SS (LO - dW S31V SOS 3^ Zl OlUZ '333 'Sl

25. FEB. 2010,112:33azaa7 IROS BATES MP - 07) 5569D675^cFAR xB MpO,MUD MABA PREMIER DEPT MCU32147

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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

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(Member for .)

OFFICE USE ONLY

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U StatQ Member Q Electorate Office Receivedq Government HoUSQ q Prime Minister

25 , FEB. 2010 12:34 ROS BATES MP - 07) 55690675PREMIER DEPT MCU

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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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birthday

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rate member rY1Government HouseR

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OFHCE USE ONLYThis form has been forwarded To the following offices;

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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

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(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 °

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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

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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

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(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

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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

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rovided is carrcct Amnda Salton - F1c,:towc ol2icuz sigmmro

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^--^drib Cgrtlficate

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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

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Birthday

Data ofanniverAAry/birth'day ®_ 4// 020 0 Date message preferred-7 - elfrequlre4(orher)

years

Coritactdetails (person makingreg4e5O

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- - - telephoAa -

'bddress ' i ' --. _ -

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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

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BAI^TON ACT 2600 PALM BEACH Q 4221'^ °° ••

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e l:Ph (02) 6271 5620 (07) 5525 0680 ,, 0 BE ,Fax (02) 6271 5662

congrawlarory^messages ter pmt,(07) $625 041Y

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gov,avjMr K0ith and Mrs Doris Blake

Nom ce(s)

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'%*)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

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Residentialress

postcode

0 Dr

S re U.R- 6?r/a , .

Address form essage pf drff rent f?om rasidentlal address)

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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

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Conte details (person makin

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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

sPir^^.o

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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Address for message (7fdiffercntfrom resldenriol address)

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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addrrs^ J h r„^ Co O I Cy rf3k __ ^ 01J P

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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

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I'm 25. FEB. 2010) 12:37-TO:MUDGEERABA

670QueenslandGovernment

nP=w,Q bIna[

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.