HERITAGE ACT 2004
					AF2017-1
For ACT Heritage Use Only	
Date received		
File No.		
Database ID		
Date to Council		
Decision date		
Accepted?		

URGENT PROVISIONAL REGISTRATION APPLICATION
Heritage Act 2004, section 30

The ACT Heritage Register contains details of places and objects of significance to the ACT.

This urgent provisional registration application form is used to request that the ACT Heritage Council (the Council) urgently decide whether to provisionally register a nominated place or object.

The Council may accept an application for urgent provisional registration only if the place or object is nominated to the ACT Heritage Register. If the place or object is not already nominated, you will need to submit a nomination application form in conjunction with this application.

Any person can request an urgent decision on provisional registration. In making this application, you are asked to identify why an urgent decision is needed. 

The Council must only accept an application for an urgent decision on provisional registration if it is 
satisfied an urgent decision must be made because: 

1.	the Council believes on reasonable grounds that the place or object is likely to have heritage significance and if a decision is not made, one or more of the following is reasonably likely to occur: 
a.	the likely heritage significance of the place or object will be diminished or damaged; 
b.	a development approval will authorise an action that will diminish or damage the place or object or;
2.	the Council believes on reasonable grounds that the application is reasonable in the circumstances.  
If the Council accepts this application, it must, as far as practicable, make a decision about provisional registration within 20 working days for an individual place or object or 60 working days for a precinct. If the Council dismisses this application, the Council must notify you of the dismissal as far as practicable within 15 working days of the decision.

A current heritage significance assessment of the place or object prepared by an appropriately qualified professional must accompany a request for urgent decision on provisional registration. Please see further information at the end of this form.

A fee applies and is payable within 5 working days of making this application. A schedule of fees is available on the ACT Heritage website at www.environment.act.gov.au/heritage. 

DO YOU REQUIRE MORE INFORMATION OR NEED HELP?
If you need help completing this form, contact ACT Heritage on 13 22 81 or 
email heritage@act.gov.au. Incomplete or inadequate forms will be returned with feedback.

 LODGING YOUR FORM
Please send this form
o by mail to: The ACT Heritage Council, GPO Box 158, Canberra  ACT 2601; 
o by hand to: ACT Heritage, Dame Pattie Menzies House, 16 Challis Street, Dickson ACT
o	 by email to: heritage@act.gov.au 
A request for urgent provisional registration will not be accepted unless signed and dated.

01 DETAILS OF PLACE OR OBJECT

Place 		Object 

Type: 		natural 		Aboriginal 	 historic		other/combined

Name of place/object:	_________________________________________________________

Other names if any:	_________________________________________________________

Is the place/object already nominated to the ACT Heritage Register?	  

Yes 	 No	Unsure

If the place or object is not already nominated, you must also complete a nomination application form.

Location:	________________________________________________________________
Address							Suburb

_______________________________________________________________________________________________
Block/Section/District/Division (If multiple addresses or blocks and sections, list all)

_______________________________________________________________________________________________
Description of place’s boundary or objects components

For Aboriginal places, natural or rural locations: 
attach a sketch map, map references and/or GPS coordinates.
	
Exact locations of Aboriginal places are treated as restricted information and should not be divulged to other
parties. 

02 YOUR DETAILS

Name:		________________________________________________________________
Title		First Name			Surname

Organisation	________________________________________________________________
Organisation Name (if the organisation is the nominator)	Position

Postal Address:________________________________________________________________
Postal Address					State	Postcode

Telephone:	________________________________________________________________
Business Hours		After Hours		Mobile

		_______________________________________________________________________________
Email

Do you have any personal association with the place or object? 		yes 		no

If yes, how would describe yourself:

owner 		tenant 		neighbour

a person with traditional (Aboriginal) affiliation with the place or object

other _______________________________

03 REASONS FOR REQUEST FOR URGENT DECISION 

Please outline why you believe the Heritage Council should make an urgent decision on provisional registration for the place or object, including any imminent threats to the heritage significance of the place or object:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

04 FURTHER SUPPORTING INFORMATION, IF KNOWN
Additional attachments can also be provided

Provide any known details for the owner/s, unless   	 same as person requesting urgent decision

Is the owner/s aware of the application?  	   no 	yes 	some are (indicate which if multiple owners)
It is an expectation that professional organisations will inform the owner (if known) of the place or object being nominated prior to submitting the nomination application to the ACT Heritage Council. Professional organisations should provide the owner with an opportunity to provide input and seek an indication of whether the owner supports the nomination application. 
 
Does the owner/s support this application?      no 	   yes 	some do, attach letter/s of support if possible

Does the owner consent to you providing their personal information?   	 no	yes

If yes, fill in the information below. If no, proceed to the next section
 
Current owner:	____________________________________________________________________
Name (attach additional details if multiple owners)

Address:	____________________________________________________________________
Postal or Street Address State Postcode

Telephone:	____________________________________________________________________
Business Hours	After Hours	Mobile

		_____________________________________________________________________________
Email

List all attachments enclosed:
n.b – A current heritage significance assessment undertaken by an appropriately qualified professional must accompany this request for urgent decision.
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

05 AUTHORISATION AND PERSONAL INFORMATION DISCLOSURE STATEMENT

I apply for the ACT Heritage Council to make an urgent decision to provisionally register the place or object mentioned in paragraph 01.

The information provided here is accurate to the best of my knowledge and may be made publicly available for the purpose of registering this place or object unless otherwise indicated.

I understand that giving false or misleading information is a serious offence under 
the Criminal Code 2002.

Signed: ______________________________ 		Date: _________________

       	By ticking this box I give my consent for my name/organisation to be disclosed as the 	applicant for this request for an urgent decision on provisional registration.

The personal information on this form is provided to the ACT Heritage Council (the Council) and the Environment, Planning and Sustainable Development Directorate (EPSDD) to enable the processing of your application. The collection of personal information is required by the Heritage Act 2004 (the Act). The Act requires the details of the applicant’s name and address to be provided with an urgent provisional registration application. If all or some of the personal information is not collected EPSDD and the Council cannot process your application. EPSDD’s Information Privacy Policy contains information about how you may access or seek to correct your personal information held by EPSDD, and how you may complain about an alleged breach of the Territory Privacy Principles. The EPSDD Information Privacy Policy can be found at http://www.environment.act.gov.au/about/privacy

Signed: ______________________________ 		Date: _________________

Assessment by an appropriately qualified professional
An appropriately qualified professional means someone who has skills and experience directly relevant to the heritage significance of the place or object being assessed. There are many fields of expertise relevant to heritage significance assessment including knowledge of Aboriginal culture and history, archaeology, architecture, engineering, history, landscape architecture, nature conservation, object conservation, town planning and urban design.

It is expected that a person with skills related to the primary significance of the place or object will provide input into the assessment of heritage significance. 

For example, an assessment of:
•	the steel portal structure at the Bus Depot Market would require input from an engineer;
•	a residential precinct would require input from an architect or town planner or both;
•	an archaeological site or ruin would require input from an archaeologist;
•	a place or object with significance primarily related to historical events or activities would require input from an historian;
•	an Aboriginal place or object will require input from the local Aboriginal community;
•	a natural heritage place would require input from a person with expertise in nature conservation; and
•	a place important to the community would require assessment by a person with experience in conducting social values assessment.