Annual Disclosure of Interests Return

Annual Disclosure of Interests Return - for the period since 30 June 2022 to 30 June 2023

An annual Disclosure of Interest Return (Return) is required to be submitted by Designated Persons in accordance with City of Newcastle (CN) Codes of Conduct available on our website.

Important information

This information is being collected for the purpose of complying with clause 4.21 of the Model Code of Conduct.
You must not lodge a return that you know or ought reasonably to know is false or misleading in a material particular (see clause 4.23 of the Model Code of Conduct). Complaints about breaches of these requirements are to be referred to the Office of Local Government and may result in disciplinary action by the council, the Chief Executive of the Office of Local Government or the NSW Civil and Administrative Tribunal.
The information collected on this form will be kept by the general manager in a register of returns. The general manager is required to table all returns at a council meeting.
Information contained in returns made and lodged under clause 4.21 is to be made publicly available in accordance with the requirements of the Government Information (Public Access) Act 2009, the Government Information (Public Access) Regulation 2009 and any guidelines issued by the Information Commissioner.
You have an obligation to keep the information contained in this return up to date. If you become aware of a new interest that must be disclosed in this return, or an interest that you have previously failed to disclose, you must submit an updated return within three months of becoming aware of the previously undisclosed interest.
For helpful tips on completing your Return, refer to the Office of Local Government Guide to completing Returns of interest.

YOUR DETAILS

Name

A. REAL PROPERTY

1. Primary place of residence

2. Nature of Interest

Owner, Renter etc.

3. Please enter any other Real property you need to declare

E.g. investment property

B. SOURCES OF INCOME

4. Position title at City of Newcastle

5. List any additional income you received from another occupation at any time since 30 June 2023

List position title, name and address of other employer / or description of office held / or name under which partnership conducted (please separate each new entry with / )

6. Did you receive income from a trust at any time since 30 June 2023

List name and address of settlor; and name and address of trustee (please separate each new entry with a / )

7. Did you receive income from any other source at any time since 30 June 2023?

Include description sufficient to identify the person from whom, or the circumstances in which, that income was received.

C. GIFTS

8. Did you receive a gift or benefit since 30 June 2023

Reminder to declare those >$10, whether accepted or declined, through our Gift Declaration Form. List the name of the donor, address and description of each gift (please separate each entry with a / )

D. CONTRIBUTIONS TO TRAVEL

9. Did you receive any financial or other contribution to any travel undertaken at any time since 30 June 2023

List the name and address of donor, dates on which travel was undertaken and name of States, Territories of the Commonwealth and overseas countries in which the travel was undertaken (please separate each new entry with a / )

E. INTERESTS AND POSITIONS IN CORPORATIONS

10. Did you have an interest or held a position in corporation/s at any time since 30 June 2023

List the name and address of each corporation, nature of interest (if any), description of interest (if any) and description of principal objects (if any) of corporation (except in case of listed company) (please separate each new entry with a / )

F. PROPERTY DEVELOPER

11. Were you a property developer or a close associate of a property developer on the return date

G. POSITIONS IN TRADE UNIONS AND PROFESSIONAL OR BUSINESS ASSOCIATIONS

12. Did you have an interest or held a position in trade unions and professional or business associations at any time since 30 June 2023

List the name of the trade union or association and description of position (please separate each new entry with a / )

H. DEBTS

13. Did you have debt that you were liable to pay since 30 June 2023

Name and address of each person to whom I was liable to pay any debts at the return date/at any time since 30 June

I. DISPOSITIONS OF PROPERTY

14. Particulars of each disposition of real property by me (including the street address of the affected property) at any time since 30 June as a result of which I retained, either wholly or in part, the use and benefit of the property or the right to re-acquire the property at a later time

15. Particulars of each disposition of property to a person by any other person under arrangements made by me (including the street address of the affected property), being dispositions made at any time since 30 June, as a result of which I obtained, either wholly or in part, the use and benefit of the property

J. DISCRENTIONARY DISCLOSURES

16. Discretionary disclosures

ACKNOWLEDGEMENT

1. I acknowledge that the information contained in my Disclosure of pecuniary interests and other matters in respect of the period from 30 June 2022 to 30 June 2023 is true and correct.

Yes No

2. I note that lodging a Return that I know or ought reasonably to know is false or misleading in a material particular could amount to a breach of the Code of Conduct and may result in disciplinary action by CN, the OLG or the NSW NCAT.

Yes No

3. I consent to the use of an electronic signature to make this declaration. I understand that by typing my name in the below field I will be supplying my electronic signature

Yes No

Signature (type your full name)

Date

Attachment (if applic)

Please select a file

If you would like further information redacted from your Return (other than your residential address), please upload your ‘Request for Omission of information’ and ‘Statutory Declaration’