Sch 10LIST OF LODGERS

SCHEDULE 10—LIST OF LODGERS [Clause 8.24] The following is the name of every person who resided in the lodging house situated at .......................................................................................................................................................................... on .......................................................................................... Lodger’s name— ............................................................................. ............................................................................... ............................................................................. ............................................................................... ............................................................................. ............................................................................... ............................................................................. ............................................................................... (Signature of keeper)

4 January 2017 GOVERNMENT GAZETTE, WA 47