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Plaque and Memorial Request

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Please ensure you have read the Plaques, Monuments & Memorials Policy before completing this form.

Please note: The lodgement of a request does not guarantee approval.

Applicant details

Details of person making the request.

Beneficiary details

Plaque or memorial details

Details of individual, group or organisation to be memorialised.

Recipient type: required
Type requested required


Please note: The location of plaques and memorials is at the discretion of the Council following consideration of masterplans, safety, traffic and pedestrian mobility, and the primary use/purpose of the location. Plaques cannot be installed in isolation or affixed to existing Council assets. Plaques can only be fixed to new assets at the discretion of the Council, in accordance with Council policies and guidelines.

Upload a photo or diagram of the proposed location/area of the plaque or memorial (optional)
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Max file size: 4 mb

Details of contribution made by individual, organisation or group

Please describe the meaningful contribution(s) made to the community by the recipient.

Upload supporting evidence (optional)
Upload a file:
Max file size: 4 mb

Proposed plaque wording

If you have requested a plaque, please provide the following details (refer to example provided on Plaques, Monuments & Memorials webpage).


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