Sch 10

Schedule 10 APPLICATION FOR REGISTRATION OF PREMISES FOR OFFENSIVE TRADE I/We, .............................................................................................................................................................. (Full Name of Applicant/s) of ................................................................................................................................................................... ....................................................................................................................................................................... apply for registration, for the year ended .................................................................................................... of ................................................................................................................................................................... (Location of Premises)

9 January 2018 GOVERNMENT GAZETTE, WA 111 being premises in or upon which there is (or is to be) carried on an offensive trade, namely ........................................................................................................................................................................ ........................................................................................................................................................................ (Description of Offensive Trade) under the business name of ........................................................................................ The prescribed registration fee of $ ................. is attached. ————