Sch 5Form of notice for alterations for the purposes of religious services or rites

Schedule 5—Form of notice for alterations for the purposes of religious services or rites

Section 90(4)(a) of the Heritage Act 2017

Regulation 11

2. Owner details

If acting on behalf of the owner:

3. Proposed works or activities

Note: Exemptions from permits to carry out works or activities may apply if:

 a registered place is a place of worship or in the precincts of a place of worship; or

 a registered object is in a place of worship or in the precincts of a place of worship.

Provide a brief description of the relevant works or activities. State how the proposed works or activities are for the purposes of religious services or rites.

Note: If you do not demonstrate this here, you may be asked for additional information. If the Executive Director is not satisfied that the proposed works or activities are for the purposes of religious services or rites, your exemption will be withdrawn. If your exemption is withdrawn, you will need to apply for a permit.

$

Date that works or activities are to commence:

Note: Please submit notice at least 20 business days before works or activities are to commence.

4. Supporting documents

Plans showing the extent and nature of the proposed works or activities must be submitted with this notice (if applicable).

5. Declaration by officer of place of worship

Note: A declaration by an officer of the place of worship that the proposed works or activities are required for the purposes of religious services or rites must be included with this notice.

6. Statement

I state that the information I have given on this form is true and correct to the best of my knowledge. I understand that Heritage Victoria staff may need to inspect the registered place or registered object in relation to this notice. Heritage Victoria will explain the purpose of the visit and what needs to be done in relation to the notice. Heritage Victoria will agree a time and date for any inspection with the relevant contact.

Name of *owner/*person acting on behalf of owner:

Sch. 6 substituted by S.R. No. 13/2025 reg. 17.