ࡱ> >@= {bjbjss 0${ ?????SSSS$wSt(. suuuuuuD!pu?u?? ??ss:S,@x,VS^ _0RV"|V"V"?>",N$ruuv:V" : WESTERN AUSTRALIA OATHS, AFFIDAVITS AND STATUTORY DECLARATIONS ACT 2005 STATUTORY DECLARATION I .. {name, address and occupation of person making declaration} DO SOLEMNLY AND SINCERELY DECLARE: (*)I am the applicant for  FORMDROPDOWN  Licence No(s)_________________________ (*)I am duly authorised as the agent for __________________________________ being the applicant for  FORMDROPDOWN  Licence No(s)__________________________ (**)The Tenement Applicant has offered to enter into a Regional Standard Heritage Agreement (RSHA) with the _________________________________ (native title party) by executing the RSHA and sending it to _______________________ (postal recipient) on _________________ (date) for the __________________________ (native title party) to execute should they accept the offer. (**) The Tenement Applicant and the __________________________ (native title party) have previously entered into a Goldfields RSHA commencing ____________ (date) and terminating on __________________ (date) (note- see Attachment 5 of Goldfields RSHA if applicable). (**)The Tenement Applicant and the ___________________________ (native title party) have previously entered into an alternate heritage agreement (AHA) commencing _____________________ (date) and terminating on _____________________ (date) I believe that the Tenement Applicant has satisfied the State Government Policy conditions (by correctly completing the relevant RSHA in accordance with the RSHA checklist prepared by the Native Title Representative Body) for the inclusion of the statement, in the s.29 Native Title Act 1993 Notice, that the grant of the above  FORMDROPDOWN  Licence/s is an act attracting the expedited procedure. This declaration is true and I know that it is an offence to make a declaration knowing that it is false in a material particular. This declaration is made under the Oaths, Affidavits and Statutory Declarations Act 2005. DECLARED at this .. day of ... 20. _____________________________ before me ______________________________ Signature of person making the declaration Name of authorised witness & qualification as such a witness (*) (**) Delete whichever is not applicable. IMPORTANT This declaration must be made before any of the following persons: Academic (post-secondary institution), accountant, architect, Australian consular officer, Australian diplomatic officer, bailiff, bank manger, chartered secretary, chemist, chiropractor, company auditor or liquidator, court officer, (judge, magistrate, registrar or clerk), Defence Force officer (commissioned, warrant or NCO with 5 years continuous service), dentist, doctor, local government CEO or deputy CEO, local government councillor, loss adjustor, marriage celebrant, Member of Parliament (State or Commonwealth), minister of religion, nurse, optometrist, patent attorney, physiotherapist, podiatrist, police officer, post office manager, psychologist, public notary, public servant (State or Commonwealth), real estate agent, sheriff or deputy sheriff, surveyor, teacher, tribunal officer, veterinary surgeon. Or, Any person before whom, under the Statutory Declarations Act 1959 of the Commonwealth, a statutory declaration may be made. IMPORTANT INFORMATION: As of 1 January 2006 there is no provision for Commissioners of Declarations in 91Ƶ. GH^  $ % 3 4 5 ] ` 2 3 ; < D E M N  ~xxxxoio hHCJhH6CJ] hXCJjhRhRCJU hRCJjhRCJUjh7]PCJU h7]PCJjh7]PCJU hHCJ hHCJH*h xh xCJhfhf5h 6CJ] harCJ h xCJhH h&5\ hH5\)H^ ] n z i edh,^egdJe>dh,^e`>gdJ & F_dh,^_`gdJ edh^egd  & Fedh^e$a$gd xgd8+$a$gdargdargd&$xa$$a$ 0 D m n s  6 < = @ F i w x y z ~ 2 8 b h | EFr}ż񝗇 h&CJj`hRhRCJU hRCJjhRCJUhH6CJ]h.#Jh.#J56CJhY56CJ h.#JCJ hXCJ h7CJ h CJ h CJ hHCJH* h xCJH* hHCJhH6CJ]2i ~[CDyz~$]^a$gdF$F]^F`a$gdar$F^F`a$gdJ`gd&gd& & Fe^e`}~[DLMklwʸzrzjzjzjzjzjzjzjzjzrjrjh8BCJaJhFCJaJhFhFCJaJhar5>*CJaJhF5>*CJaJhar5CJaJh pBhJ`5hJhJ5CJ aJ hH5CJaJhJ`5CJaJh&h&5CJaJ hJ`CJh&h&5CJ\aJh{h&6CJ h&CJ hHCJ) /0WXno|} %&hjwxyxyz{Ƹharhar>*䴳aF䴳F<NCJaJh<Nh8B6CJaJh<NCJaJh8BCJaJhFCJaJ-yz{F]^F`gdar$]^a$gdF.:pa. A!"#$% D Dropdown1 Exploration ProspectingDf Dropdown2 Exploration ProspectingDf Exploration Prospecting^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH 8`8 Normal_HmH sH tH <<  Heading 1 $@&CJH@H  Heading 2$$@&a$ 5CJ \DA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] { $ }{ i { $4{ S S S 8@0(  B S  ? Dropdown1 Dropdown2$} 5} ڰڰIڰ4_ڰ!f f } w w } 9*urn:schemas-microsoft-com:office:smarttagsplace9*urn:schemas-microsoft-com:office:smarttagsState `$} ;>.7  } 3333333$5@FiwF   % & h j w x x } $5} TVvԒ+R|fG h^`CJ`OJQJo(q ^`OJQJo(o pp^p`OJQJo( @ @ ^@ `OJQJo( ^`OJQJo(o ^`OJQJo( ^`OJQJo( ^`OJQJo(o PP^P`OJQJo(hhh^h`.h88^8`.hL^`L.h  ^ `.h  ^ `.hxLx^x`L.hHH^H`.h^`.hL^`L.TV+R|W                 JxY8B pB.#J<N7]PJ`ar:ZFHJ8+ X{aY& xf7R{ } @{ x@UnknownG* Times New Roman5Symbol3. * Arial;Wingdings?= * Courier NewACambria Math"hf{qıfx x !24du u 2QHX?H*!xxWESTERN AUSTRALIABullen Chris SHARPE  Oh+'0 ( H T ` lxWESTERN AUSTRALIABullen Normal.dotmChris SHARPE4Microsoft Office Word@b@Nxߜ?@ :@Ix ՜.+,0$ px   Mineral And Petroleum Resourcestu  WESTERN AUSTRALIA Title  !"#$%&'()*+,./012346789:;<?Root Entry F A=VAData 1Tablej"WordDocument0$SummaryInformation(-DocumentSummaryInformation85CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q