COMMONWEALTH OF AUSTRALIACOMMONWEALTH OF AUSTRALIA

COMMONWEALTH OF AUSTRALIA

EMERGENCY DECLARATION UNDER SUBSECTION 21C (1) OF THE ABORIGINAL AND TORRES STRAIT ISLANDER HERITAGE PROTECTION ACT 1984

I, (insert name of person making the declaration), an inspector appointed under section 21R of the Aboriginal and Torres Strait Islander Heritage Protection Act 1984, (or) Minister of State for Aboriginal Affairs, (or) Magistrate of the State of Victoria, (where the declaration is made by an inspector or the Minister or where the declaration is made by a magistrate on an application by a local Aboriginal community, insert after an application made to me by (insert name of local Aboriginal community), a local Aboriginal community, (or where the application for the declaration was made by another person, insert name, description and address of that person) (or where the declaration is made by an inspector or the Minister on his or her own motion, insert on my own motion,) hereby make under subsection 21C (1) of the Aboriginal and Torres Strait Islander Heritage Protection Act 1984 an emergency declaration in relation to (describe or refer to each Aboriginal place or Aboriginal object that is the subject of the declaration in a manner that is sufficient to identify it) (if the declaration is to be subject to any terms, for example, if the manner of preservation to be adopted in relation to that place or object is to be specified, if the manner of removing a specified threat of injury to that place or object is to be specified, or if a prohibition of access to, or interference with, that place or object is to be specified, specify those terms).

Dated 19 .

(Signature of person
making the declaration)

Schedule 3

(subregulation 9 (1))

Form Identity Card No.