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Summary of matters to disclosure:

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Description of any documents provided or name/s of witnesses

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Agreement:

By signing this form you agree that the information you have been provided is true and accurate to the best of your knowledge and understand that under Section 87(1) of the Public Interest disclosures Act 2002, it is an offence for a person to knowingly provide false information under the Act to certain officers (including the Ombudsman) with the intention that it be acted on as a disclosed matter. The provision provides for a maximum penalty of 240 penalty units or two year’s imprisonment, or both.

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Document name: Public Interest Disclosure Form v1

Unique Document ID: e99e7d0636b666c4a51cfbc23c815c53021adddf

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Timestamp	Audit
March 13, 2020 2:46 pm AEST	Public Interest Disclosure Form v1 Uploaded by Devonport Council - [email protected] IP 1.152.104.92

This audit trail report provides a detailed record of the online activity and events recorded for this document.

https://www.devonport.tas.gov.au/

Audit Trail Serial# 548b9c2efa93f640630b9914565d0036