form 2-register of interests o a councillor and their related persons · 2017-06-05 · form...

Form 2-Register of interests o a councillorand their related persons

This form is to be used

a. for initial lodgement of your register of interestsb. to amend your existing register of interests.

For a councillor - complete section A.For a councillor's related person - complete sections A and B.

Relevant sections in the Local Government Regulation 2072 have been indicated in italics.

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I. Particulars

Department of Infrastructure, Local Government and Planning

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A. Particulars of councillor

Full name:

Local government:

Position:

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B. Particulars of related personFull name:

Relationship tocouncillor:

Signature and date of statementDate of statement.

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is aocum, . . t you with completing your register of interests.

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Version No: April20,5

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QueerslandGovernment

2. Financial and non-financial particulars

2.1 Shareholdings or controlling interests in corporations

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I. Name of corporation 2(a)

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2.

ControllingInterest?

3. Share oldings of the corporation in othercorporati ns 2(b)

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Register of Interests for councillors and councillors related persons

4.1s the shareholdingheld in a proprietycompany? 2(c)(if yes complete 2.2)

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2.2 Shareholdings or controlling interests in corporations (continued)3.1s this a

subsidiary to theholdingcompany?2(c)(ii)

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I. Name of

proprietarycompany 2(c)

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2. Company's investments 2(c)(i)2(c)(ii) and 2(d)

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4. List the investments of the subsidiary company2(c)(iii) 2(c)(iv) *^^e rote^

Register of interests for councillors and councillors related persons

Signature:

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Date: I f7. ^19


3. Positions held as an officer of corporations

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Name of

corporation 3(a)

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Nature of corporation'sactivities 3(c)

4. Beneficial interests in trusts or nominee corporations

Name (ordescription) of trustor corporation'sname 4(a)

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Nature of office held 3(b)

Nature of activities of

trustlcorporation 4(b)

5. Self managed superannuation fund

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Name or description of thefund 5(2)(a)

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Nature of interest 4(c)

The nature of theactivities of the fund

5(2)(b)


The investments or other

interests in property held, ofwhich the relevant person isaware, by the fund 5(2)(c)

Signature Date:1.5:.^2.1


6. Trustee of family or business trusts

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g Name (or^ description) of trusta; 6(a)

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trust 6(b)

7.1nterests in partnerships and joint ventures

Name (ordescription) ofpartnershipljointventure 7(a)

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Name of each beneficiary or classof beneficiary 6(c)


partnershipljoint venture7(b)

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8.1nterests in land

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Suburb or localityof land 8(a)

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Nature of interest 7(c)

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Approximatesize of land

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Purpose for whichland isused/intended to

be used 8(c)

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Register of Interests for councillors and councMor's related persons

Nature of interest 8(d)

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Date! 5~ 10*{, I


9. Liabilities more than $10,000 (excluding department store and credit card accounts)

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Nature of liability 9(, )(a)

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IO. Debentures and similar investments

Name of

corporation theinvestment is in

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Name of creditor 9(, )(b)

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Nature of corporation'sbusiness IO(c)

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11. Savings and investment accounts held with financial institutions

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Name of institution I I(b)

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Nature of investment ,0(a)

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Nature of account ,,(a)

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Date:


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I2. Gifts over $500 or all gifts totalling more than $500

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Name of donor I2(, )(a)

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I3. Sponsored hospitality benefits

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Source of the contribution for travel or

accommodation received , 3(a)

Description of the giftls 12(,)(b)

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14. Memberships of political parties, bodies, associations and trade or professionalorganisations

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Purpose of the benefit received I3(b)

Name of organisation I4

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Address of organisation 14


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Signature:

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I5. Other assets over $5,000

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Details of other asset/s I5

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I6. Other sources of income more than $500 a year

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Source of income ,6

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17. Other financial or non-financial interests known to the relevant person that raise,appear to raise or could potentially raise, a conflict between the interest and your dutyas a councillor

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Other interests I7

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Register of Interests for councillors and councillors related persons

Signature: Date: ^'~I^',,"


General notes

Adding a particularPlace a cross in the 'add' box in the left hand column when adding a new particular to your register of interests.

Removing a particularPlace a cross in the 'remove' box in the left hand column when removing a particular from your register of interests.

If there is insufficient space on this form for all of the details you are required to give you may attach additionalpapers for that purpose. You must sign and date each additional paper.

When completing this form, insert the words 'not applicable', where appropriate.

The completed form (with an envelope marked 'confidential') is to be sent, within 30 days of commencement ofduty or any changes of circumstances to the chief executive officer of your local government.

Related personsA person related to a councillor need not include information regarding an interest held jointly or in common withthe councillor which is already included in the councillor's register of interests.

Section notesThe header of each field includes a reference in italics to the relevant section in Schedule 5 of the Local

Government Regulation 2012.

The following notes may assist you with completing your register of interests -

# Notes

If a councillor, complete section AIf a related person to a councillor, complete section A and B

2.1

I . If relevant person is a shareholder or has a controlling interest in A Corporation includes-a corporation state the name of the corporation. . a company

2. If the relevant person holds a controlling interest in the . any body corporate (whether incorporated incorporation tick the box. this jurisdiction or elsewhere)

3. List the shareholdings of the corporation in any other . an unincorporated body that under the law ofcorporation/s. its place of origin, may sue or be sued, or

4. If any of the shareholdings are held in a proprietary company/s may hold property in the name of itstick the box and move on to section 22 secretary or of an office holder of the body

duly appointed for that purpose.

Holding company-in relation to a body corporate,means a body corporate of which the first bodycorporate is a subsidiary

Proprietary company-A proprietary company is acompany that is registered as, or converts to, aproprietary company under the Corporations Act2007

2.2

I. State the name of the proprietary company/s.2. List any investments of the proprietary company/s3. If any of the investments are a subsidiary to the proprietary

company tick the box.4. In column four list the investments of the subsidiary company

you have listed in column two and if the investments include asubsidiary to that company, state the name of the company orits investment(s)-you may need to provide this information in aseparate signed attachment

Definitions

A related person is a spouse, a dependent childor someone whose affairs are so closelyconnected with the affairs of a councillor, chiefexecutive officer or senior executive employee,that a benefit derived by that person, or asubstantial part of it, could pass to the councillor,chief executive officer or senior executiveem 10 ee.

The number or monetary value of shares does not need to bestated.

The monetary value of investments does not need to be stated.


Share means any of the following-. a share in the share capital of the corporation. stock

. a convertible note or

. an option contract


Complete if you are an officer of a corporation, in duding if youare an officer of any corporations you have stated in section two.

Subsidiary-A body corporate is a subsidiary ofanother body corporate if, and only if. the other body:

o controls the composition of the firstbody's board or

o is in a position to cast, or control thecasting of, more than one' half of themaximum number of votes that

might be cast at a general meetingof the first body or

o holds more than one-half of the

issued share capital of the first body(excluding any part of that issuedshare capital that carries no right toparticipate beyond a specifiedamount in a distribution of either

profits or capital) or. the first body is a subsidiary of a subsidiary of

the other body.

Officer of a corporation means. a director or secretary of the corporation; or. a person:

o who makes, or participates inmaking, decisions that affect thewhole, or a substantial part, of thebusiness of the corporation or

o who has the capacity to affectsignificantly the corporation'sfinancial standing or

o in accordance with whose

instructions or wishes the directors

of the corporation are accustomedto act (excluding advice given by theperson in the proper performance offunctions attaching to the person'sprofessional capacity or theirbusiness relationship with thedirectors or the corporation) or

. a receiver, or receiver and manager, of theproperty of the corporation or

. an administrator of the corporation or

. an administrator of a deed of companyarrangement executed by the corporation or

. a liquidator of the corporation or

. a trustee or other person administering acompromise or arrangement made betweenthe cor oretion and someone else.

Trust^joes riot include the duties incidental to an

estate conveyed by way of mortgage, but with thatexception trust extends to implied, resulting, bareand constructive trusts, and to cases where thetrustee has a beneficial interest in the trust

property, and to the duties incidental to the officeof a personal representative.

Nominee corporation-means a corporationwhose principal business is holding marketablesecurities as a trustee or nominee.

Director-see the Corporations Act 2007

If providing a description of the trust or nominee corporation, thedescription must be sufficient to identify the trust or corporation

The monetary value of beneficial interests does riot need to bestated.

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Complete if you are a trustee of the fund or, if the trustee of thefund is a cor oration, a director of the trustee.If providing a description of the trust, the description must besufficient to identify the trust

Page 70Register of interests for councillors and councillors related persons

Trust-does riot include the duties incidental to an

estate conveyed by way of mortgage, but with thatexception trust extends to implied, resulting, bareand constructive trusts, and to cases where thetrustee has a beneficial interest in the trust

property, and to the duties incidental to the officeof a personal representative.

Version No: April2015

If providing a description of the partnership or joint venture, thedescription must be sufficient to identify the partnership or jointventure.

Includes any land leased, owned or mortgaged, whether theinterest is held alone, jointly or in common with any other person.

Examples of property where you may hold an interest:

o Residential property leased, owned or mortgaged by youwhich may be your place of residence or where you haveestablished a business

Commercial property leased, owned or mortgaged by youwhich may be where you have established a business

Residential property where you are the lessor of a propertyto another party.

Commercial property where you are the lessor of a propertyto another party.

For privacy reasons, if the lessee is a corporation, state thename of the corporation (individuals do riot need to bestated)

Investment property-properly held for capital gain (riotleased or inhabited)

o Native Title land-granted or where an application ispending.

The full street address of the property does not need to bestated.

Joint venture-business enterprise for which twoor more parties join forces (riot necessarily inpartnership or by the formation of a company)

Partnership-the legal relationship of personscarrying on some business together with a view toprofit (provided that they are riot members of aninco orated bod

The monetary value of investments or beneficial interests doesnot need to be stated.

Amounts of $10,000 orless do not need to be disclosed

The debt does not need to be disclosed if it arises from the

supply of goods or services supplied in the ordinary course ofyour business or the business of a trust or private company.

The financial amount of liabilities does riot need to be stated

A line of credit does not need to be disclosed until such time as it

is used.

May include such investments as a term life insurance policywhere a return of the policy's premium may occur.

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The moneta value of investments does riot need to be stated

The account number of, or financial amounts held in, savings orinvestment accounts do riot need to be stated.

This does riot include gifts received from related persons or other Gift means either of the following-. the transfer of money or other property:persons related by blood or marriage or friends

o without consideration or

o for a consideration substantially lessthan full consideration or

Includes election donations made to an individual councillor and

election donations made to a group of candidates of which thecouncillor is associated with.

Private company-means a proprietary companyin which a relevant person holds securities

Trust-means a trust of which a relevant personis a beneficiary

Page ifRegister of interests for councillors and councillors related persons

Debenture-see the Corporations Act 2007

. a loan of money or other property made on apermanent or indefinite basis, other than anoverdraft facility.


This does riot include incidental travel or accommodation thatinvolve little to no value. For example, sleeping a night at afamily or friend's house or car pooling arrangements.

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15Includes honora atrons, honora members etcThis excludes:

o household and personal effectso motor vehicles used mainly for personal useo su erannuation entitlements

Includes income of a proprietary company and of trusts in whichthe relevant person has an interest.Includes any employment where earnings are more than $500

The particulars required for each other interest of a relevantperson are sufficient details of the interest to identify it.

er ear.

A person receives a sponsored hospitality benefitif-

. the person, other than in an officialcapacity-

o undertakes travel or

uses accommodation ando

. a contribution, whether financial or non-financial, for the cost of the travel oraccommodation is made by another person.

Note: A person does riot however receive asponsored hospitality benefit if the contributionwas made by the person's spouse, or other familymember or friend unless there could be a

perception of a conflict of interest, financial orotherwise, relatin to the contribution.

Important note

Failure to complete or update a register of interests can give rise to an offence, with associated penalties to amaximum of $9350 (85 penalty units), or $1,000 (too penalty units) if a councillorintentionally fails to complete orupdate their register of interest, and/or disqualification from holding office as a councillor for four years.

If you are unsure of your obligations with respect to registers of interest, it is strongly recommended that you seekindependent professional advice to clarify your understanding of your obligations.

Further information

When completing this form, you should refer to the Local Government Act 2009 (the Act) and the LocalGovernment Regulation 2012 (the Regulation) relating to the disclosure and registration of interests for a councillorand their related persons.

See WWW Ieqislation. qld. qov. au for a copy of the Regulation and the Act.

Interest, of the relevant person, means a financialinterest or non-financial interest-

. of which the relevant person is aware and

. that raises, appears to raise, or could raise, aconflict between the relevant person's dutyunder the Act and the holder of the interest.

Department of Infrastructure, Local Government and PlanningLevel 12 Executive Building, 100 George Street, Brisbane Qld 4000tel 13 QGOV (137468)info@diloo. old. qov. au

WWW. dilqp. qld. qov. au Version No: April20,5

form 2-register of interests o a councillor and their related persons · 2017-06-05 · form...

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