Legal Consent to Suburb Name Form

Legal Consent to Suburb Name Form

This Legal Consent to Suburb Name Form is made on the day of in the year between Applicant Name: (Applicant) of Address: and Consent Provider Name: (Consent Provider) of Address: .

Recitals

WHEREAS the Applicant has requested that a new suburb name be assigned to the locality described herein and has proposed the name (Proposed Name);

WHEREAS the Consent Provider is an owner or lawful representative of the land, community association or body corporate whose interests will be affected by the Proposed Name and is qualified and authorized to give the consent set forth in this document;

WHEREAS the parties intend by this instrument to set forth the Consent Provider's express consent, representations, warranties and conditions relating to the Proposed Name and any associated public designation, signage and records.

NOW THEREFORE, in consideration of the mutual covenants and agreements contained herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the parties agree as follows:

1. Definitions

For purposes of this Form, the following terms shall have the meanings set forth below:

"Consent" means the Consent Provider's written consent to the adoption, use and recording of the Proposed Name as set forth in Section 2 below. "Effective Date" means the date on which this Form is signed by both parties.

2. Grant of Consent

The Consent Provider hereby grants to the Applicant the Consent to use and record the Proposed Name for the locality and agrees that the Consent Provider will not oppose the Applicant's submission of the Proposed Name to any competent authority, mapping agency or registrar responsible for place names, provided such submission is substantially consistent with the description and scope set forth in this Form.

3. Representations and Warranties

The Consent Provider represents and warrants to the Applicant that: (a) the Consent Provider has full authority to grant this Consent; (b) there are no outstanding agreements, easements, covenants or legal impediments known to the Consent Provider that would prevent the Proposed Name from being adopted for the described locality; and (c) the Consent Provider's execution of this Form does not violate any applicable law, covenant or contractual obligation.

4. Covenants

The Consent Provider covenants to cooperate reasonably with the Applicant in the submission and verification of materials necessary to evidence the Consent, including execution of further documents where reasonably required, provided that such further documents do not materially expand the obligations of the Consent Provider beyond those set out in this Form.

5. Indemnity

The Consent Provider agrees to indemnify and hold harmless the Applicant and its officers, agents and successors from and against any and all losses, claims, damages, liabilities and expenses (including reasonable legal fees) arising out of any breach of the representations, warranties or covenants made by the Consent Provider in this Form.

6. Notices

Any notice, demand or communication required or permitted under this Form must be in writing and delivered to the addresses set forth at the beginning of this Form or to such other address as either party may designate by notice to the other in accordance with this Section. Notice is effective upon personal delivery, overnight courier receipt, or three (3) business days after deposit in the mail.

7. Governing Law

This Form shall be governed by and construed in accordance with the laws of the jurisdiction in which the land described in the Property Description is located, without regard to conflict of law principles.

8. Entire Agreement

This Form constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior negotiations, understandings and agreements, whether written or oral, relating to that subject matter.

9. Severability

If any provision of this Form is held to be invalid, illegal or unenforceable in any respect under any applicable law, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired.

10. Amendments; Waiver; Counterparts

Any amendment to this Form must be in writing and signed by both parties. No waiver of any provision of this Form shall be effective unless in writing and signed by the party against whom the waiver is asserted. This Form may be executed in counterparts, each of which shall be an original and all of which together shall constitute one instrument.

11. Additional Acknowledgments

The Consent Provider acknowledges that this Consent may be relied upon by the Applicant in submissions to authorities and third parties and that the Consent Provider shall promptly notify the Applicant in writing of any change in ownership or circumstance that affects the authority to grant this Consent.

Acknowledgement of Identity and Authority

The undersigned Consent Provider affirms under penalty of perjury that the person executing this Form on behalf of the Consent Provider is authorized to do so and that the information provided in this Form is true and correct to the best of the Consent Provider's knowledge.

I confirm that I am the owner or authorized representative entitled to give consent: Yes

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