Please forward completed form to the ACT Revenue Office at:
PPD@act.gov.au    OR   P.O. Box 293, Civic Square, ACT, 2608                                  *Indicates mandatory fields

Part 1: Property and Owner Details	
Suburb: *	 	Section:*	 	Block:*	 	Unit:	 	
Account Number:*	 	
Property Address:*	 	
Owner/s Name:*	 	
Telephone:*	 	
Email Address:	 	

Part 2: Rental Status Details*	
1. Date Rental Commenced:	 	
2. Date Rental Ceased:	 	
3. Date Part Rental Commenced: E.g. Dual occupant or granny flat	 	3b. Percentage of total premises rented:	 	

Part 3: Real Estate Agent Details - if agent is acting on behalf of owner	
Agency Name:	 	
Telephone:	 	
Email Address:	 	

Part 4: Address for Service of Notices - if address is to be updated	
Postal Address:	 	
Email:	 To receive your notices via email please register on our website www.revenue.act.gov.au	

The Land Tax Act 2004 (Sections 14(1) and 14 (2)) requires the owner of a parcel of residential land to notify the Commissioner of the ACT Revenue in writing, within 30 days, if the property continues to be rented on the change of ownership or subsequently becomes rented at any time. An agent may be required to fulfil and undischarged obligation of a taxpayer.
Please Note: Giving false or misleading information is a serious offence.