1.Details as Listed in the Current Edition

Current Listing-Business/Family Name*

Current Listing-Given Names/Initials

Current Listing Address

Current Listing-Phone No. (Mobile or Landline)

2. New Details as Required in Next Edition

Reason for listing change:

Details Incorrect
Marital Status
New listing
Moved house
Deceased
Left the Riverland
Listing not Required

New Listing-Business/Family Name*

New Listing-Given Name/Initials

New Listing-Address*

New Listing-Phone No.*

Name of person authorising request*

Contact Number of person authorizing