Appendix E: Form 21
Form 21 - Submission on publicly notified requirement for designation or heritage order or alteration of designation or heritage order
Sections 168A, 169, 181, 189A, 190, and 192(f), Resource Management Act 1991
To [name of territorial authority]
Name of submitter: [full name]
This is a submission on a notice of requirement from [name of ter-ritorial or other local authority, Minister, requiring authority, or heritage protection authority who gave notice of requirement] for a designation (or a heritage order or an alteration to a designation or an alteration to a heritage order) (the notice of requirement).
[Briefly describe -
- the relevant designation, heritage order, or alteration; and
- the site or place to which the designation or heritage order applies.]
The specific parts of the notice of requirement that my submission relates to are:
[give details].
My submission is:
[include -
- whether you support or oppose the specific parts of the notice of requirement or wish to have them amended; and
- reasons for your views].
I seek the following recommendations or decision from the territorial authority:
[give precise details, including the general nature of any conditions sought].
I wish (or do not wish) to be heard in support of my submission.
* If others make a similar submission, I will consider presenting a joint case with them at a hearing.
* Delete if you would not consider presenting a joint case.
..................................................
Signature of submitter
(or person authorised to sign
Form 21 - continued
on behalf of submitter)
..................................................
Date
Address for service of submitter:
Telephone:
Fax/email:
Contact person: [name and designation, if applicable]
Note to applicant
You must serve a copy of your submission on the person who gave the notice of requirement as soon as reasonably practicable after you have served your submission on the territorial authority (unless the territorial authority itself gave the notice of requirement).
