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Nomination for Mayor or Councillor
For Candidates Endorsed by a Registered Political Party
Schedule of Information for
JENNIFER ANNE HORSBURGH
(name of candidate)
To ensure you are properly nominated as a candidate, you must complete parts A–F of this form. All information provided in this section will be made available for public inspection, unless otherwise indicated. The following definitions provide the meaning of terms used in this nomination form.
Close associate of a candidate means any person or entity with the following relationship with the candidate:
  • a spouse;
  • a partner in a partnership; or
  • an entity, other than a government entity, for which the candidate is an executive officer or board member.
Contractual arrangement means:
  • an arrangement for which the Local Government Act 2009 or the City of Brisbane Act 2010 prescribes contracting procedures that the local government must comply with in making the arrangement; or
  • an arrangement provided for under the Local Government Act 2009 or the City of Brisbane Act 2010 that allows a local government to enter into a contract without first inviting quotes or tenders. Questions regarding this definition should be directed to the Department of Local Government, Racing, and Multicultural Affairs.
Contractual process means a process provided for under the Local Government Act 2009 or the City of Brisbane Act 2010 that is preliminary to the making of a contractual arrangement with the local government. Questions regarding this definition should be directed to the Department of Local Government, Racing, and Multicultural Affairs.
Dedicated campaign bank account means an account held with a financial institution into which all gifts/loans will be directly deposited, and from which all expenses related to the campaign must be paid.
Large-sized contractual arrangement means a contractual arrangement with a supplier that is expected to be worth, exclusive of GST, $200,000 or more in a financial year, or over the proposed term of the contractual arrangement.
Medium-sized contractual arrangement means a contractual arrangement with a supplier that is expected to be worth, exclusive of GST, $15,000 or more but less than $200,000 in a financial year, or over the proposed term of the contractual arrangement.
It is a crime to knowingly give information in this document (including any attachments) that is false or misleading. The maximum penalty for doing so is 7 years imprisonment under s169 of the Local Government Electoral Act 2011.
Part A: Dedicated campaign bank account
As a candidate, I will operate the following dedicated campaign bank account:
Name of financial institution
(not to be published) 		BSB (not to be published) Account number (not to be published) Account name (not to be published)
Part B: Mandatory training
I have successfully completed the mandatory training required by s26(2) of the Local Government Electoral Act 2011 in the last 6 months.
The Unique ID number I received at the conclusion of the training is
114359378
Privacy Statement: The Electoral Commission of Queensland is collecting this information for the purposes of accepting nominations for a local government election. Unless otherwise indicated, all information provided in this nomination form may be published on the ECQ's website, as required by s32 of the Local Government Electoral Act 2011 . Form 5 LGA 01-2020 page 1 of 6
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Nomination for Mayor or Councillor
For Candidates Endorsed by a Registered Political Party
Part C: Political party, trade or professional organisation membership
Enter the following details for all registered political parties, trade or professional organisations for which you are (or were at any time in the past 12 months) a member:
Name of party/organisation Address of party/organisation Date of membership Date membership ceased (if applicable)
Animal Justice Party 470 St. Kilda Rd, Melbourne 3004 03/02/2019
Qld College of Teachers GP Box 702 Brisbane 4001 01/02/1992
Please attach additional pages in the same format if there is insufficient space on this form.
OR
I have not been a member of any registered political party or trade or professional organisation at any time over the past 12 months, nor am I currently such a member.
Part D: Contractual arrangements with council
Enter the following details for all contractual arrangements which you are (or were at any time in the past 12 months) a party to:
Nature of arrangement Size of arrangement (i.e. medium-sized or large-sized)
Please attach additional pages in the same format if there is insufficient space on this form.
Enter the following details for all contractual arrangements which a close associate to you is (or was at any time in the past 12 months) a party to:
Name of close associate & nature of relationship with candidate Address of close associate (not to be published) Nature of arrangement Size of arrangement (i.e. medium-sized or large-sized)
Please attach additional pages in the same format if there is insufficient space on this form.
OR
I have not been a party to any contractual arrangement with the council (for which I am nominating) at any time in the past 12 months, nor am I currently a party to such an arrangement. I also confirm that my close associates are not and have not been a party to any contractual arrangement with the council at any time in the past 12 months.
Privacy Statement: The Electoral Commission of Queensland is collecting this information for the purposes of accepting nominations for a local government election. Unless otherwise indicated, all information provided in this nomination form may be published on the ECQ's website, as required by s32 of the Local Government Electoral Act 2011 . Form 5 LGA 01-2020 page 2 of 6
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Nomination for Mayor or Councillor
For Candidates Endorsed by a Registered Political Party
Part E: Contractual processes with council
Enter the following details for all contractual processes which you are (or were at any time in the past 12 months) a party to:
Nature of process
Please attach additional pages in the same format if there is insufficient space on this form.
Enter the following details for all contractual processes which a close associate to you is (or was at any time over the previous year) a party to:
Name of close associate & nature of relationship with candidate Address of close associate (not to be published) Nature of process
Please attach additional pages in the same format if there is insufficient space on this form.
OR
I have not been a party to any contractual process with the council (for which I am nominating) at any time over the past 12 months, nor am I currently a party to such a process. I also confirm that my close associates are not and have not been a party to any contractual process with the council at any time in the past 12 months.
Part F: Particular applications or representations
For each of the following applications or representations which may have been made by you, provide details of the nature of the interest for each application or representation which was not decided at the time of this nomination:
  • A development application under the Planning Act 2016 for which the council is the assessment manager;
  • A development application under the repealed Sustainable Planning Act 2009 for which the council is the assessment manager;
  • A change representation under the Planning Act 2016 for which the council is the assessment manager or responsible entity; and/or
  • An extension application under the Planning Act 2016 for which the council is the assessment manager.
Nature of applications or representations
Please attach additional pages in the same format if there is insufficient space on this form.
Privacy Statement: The Electoral Commission of Queensland is collecting this information for the purposes of accepting nominations for a local government election. Unless otherwise indicated, all information provided in this nomination form may be published on the ECQ's website, as required by s32 of the Local Government Electoral Act 2011 . Form 5 LGA 01-2020 page 3 of 6
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Nomination for Mayor or Councillor
For Candidates Endorsed by a Registered Political Party
In relation to the same applications / representations outlined on the previous page, provide the following details for all applications or representations which a close associate of you made, which were not decided at the time of this nomination:
Name of close associate & nature of relationship with candidate Address of close associate (not to be published) Nature of applications or representations
Please attach additional pages in the same format if there is insufficient space on this form
OR
I am not currently a party to any outstanding applications or representations which were not decided before this nomination is made. I also confirm that my close associates are not parties to any outstanding applications or representations which were not decided before this nomination is made.


I,
JENNIFER ANNE HORSBURGH
 (the candidate)
have reviewed the above information and confirm that it is, to the best of my knowledge, true and accurate.
Signature of candidate
Date
/ /
(dd/mm/yyyy)
Privacy Statement: The Electoral Commission of Queensland is collecting this information for the purposes of accepting nominations for a local government election. Unless otherwise indicated, all information provided in this nomination form may be published on the ECQ's website, as required by s32 of the Local Government Electoral Act 2011 . Form 5 LGA 01-2020 page 4 of 6
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Nomination for Mayor or Councillor
For Candidates Endorsed by a Registered Political Party
Endorsed Candidate's Consent
Candidate details (as enrolled)
Title
Family name
HORSBURGH
 Given name
JENNIFER ANNE
Other names
Date of birth
/ /
Gender
Female
 Occupation
RETIRED TEACHER
Note: If you are enrolled on the Electoral Roll as a Silent Elector, do not insert your address details here but please separately supply the ECQ or the Returning Officer with an address for contact purposes.
Enrolled address
Postal address (if different)


Name to appear on ballot paper
Jennifer HORSBURGH

Contact details
Contact information will be published on the Commission's website. If you do not wish some or all of the contact details to appear on the web, please indicate by ticking the "No" boxes.
Family name
HORSBURGH
 Given name
JENNIFER ANNE
Postal address
Business hours phone
After hours phone
Mobile phone
Facsimile
Email address
Privacy Statement: The Electoral Commission of Queensland is collecting this information for the purposes of accepting nominations for a local government election. Unless otherwise indicated, all information provided in this nomination form may be published on the ECQ's website, as required by s32 of the Local Government Electoral Act 2011 . Form 5 LGA 01-2020 page 5 of 6
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Nomination for Mayor or Councillor
For Candidates Endorsed by a Registered Political Party
Endorsed Candidate's Declaration
I,
JENNIFER ANNE HORSBURGH
 , the candidate in the nomination,
hereby state that I am the candidate endorsed by the
Animal Justice Party
(name of Registered Political Party)
and nominated by the *Registered Officer / *Deputy Registered Officer of that Party for:
Mayor OR      Councillor
for the Local Government Area / Division / Ward of
Gold Coast City
Note: It is the responsibility of the candidate to ensure that he/she is eligible for nomination.
Conditions
1. I am enrolled on the electoral roll for an address within the Local Government Area

2. I am an Australian Citizen (please tick one box only and complete appropriate details):
by birth Place of birth
Sydney
by Grant of Australian Citizenship Date
/ /
(dd/mm/yyyy)
by other means Give details

3.
I am not a disqualified person under the relevant legislation
(Local Government Act 2009 or City of Brisbane Act 2010)
4. I have completed and signed the attached Schedule of Information
Signature of candidate
Date
/ /
(dd/mm/yyyy)

* strike out whichever is inapplicable
Privacy Statement: The Electoral Commission of Queensland is collecting this information for the purposes of accepting nominations for a local government election. Unless otherwise indicated, all information provided in this nomination form may be published on the ECQ's website, as required by s32 of the Local Government Electoral Act 2011 . Form 5 LGA 01-2020 page 6 of 6