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SOUTH AUSTRALIA BLACK SPOT NOMINATION FORM All nominations must have this Page completed. Incomplete nominations may be rejected. Tick boxes where indicated
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City

Smithville / Suburb/Town / /

Currency

pence / USD / /

Facility

National Highway / /

IndustryTerm

Will services/ utilities / Web link / /

Organization

ONLY TO BE COMPLETED BY DPTI OR LOCAL GOVERNMENT / Local Government / Council on State / For Council / /

Position

/ Prime Minister / Governor / /

Region

SOUTH AUSTRALIA / /

URL

http /

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