Form: 04YA Licence: 98M111 Ed ition: 0308

APPLICATION FOR A POSSESSORY TITL E

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Ne w S o u t h W al es Sec ti on 4 5D R ea l P roper t y A c t 1 9 00 PRI V A C Y N O T E : S ec ti on 31B o f the Re a l P rope r t y A c t 1 9 00 (R P A c t ) a uthoris es the R e gis tra r Ge ne r al t o c ol le ct the i nfor m a ti on re qui re d b y thi s f o rm fo r the e sta bl is hm e nt a nd m ai nte na nc e o f the R e a l P roper t y A c t Re gis te r. Sec ti on 96B R P A c t re qui re s tha t the Re gis ter is m a de av ai l a bl e t o a ny pe r s o n f o r s ea r c h u p o n pa y me nt o f a fee , i f a ny. S T AM P D U T Y Office of State Revenue use only

(A) T O R R E N S T IT L E (B) L OD G E D B Y

<<Sell|Forms|Title Reference/Folio Identifier>>

Delivery Bo x Name, Address or DX and Telephone C O DE

Reference (optional): (C) R E GI S T E R E D PR OP R IE T OR (D) A P P L I C A N T (E) (F) TE N A N CY :

<<Sell|Our Reference>>

YA

<<Sell|Forms|Registered Proprietor>>

Th e ap plica nt a pplies to be re gister ed as pro priet or of an est ate in fe e sim ple in the la nd spe cifie d abo ve fr e e fro m the follo w ing

(G) E N C U M B R A N C E S 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . and undertakes to pay the additional fees prescribed by item 6 of Schedule 5 of the Real Property Regulation 1998. (H) In support of this application the following documents are lodged herewith 1. Statutory declaration by the applicant; 2. 3. (I) Statutory declarations by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; Letter fro m an authorised officer of the council regarding payment of rates;

4. Cert ificate by a registered surveyor. S T A T U T O R Y D E C L A R A TI ON * I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . solemn ly and sincerely declare that 1. 2. 3. 4. There are no documents ev idencing t itle to the above land in the possession or contro l of the applicant other than those included in Schedule 1; Except as shown on the relevant folio of the Register the applicant is not aware that any person other than herself/himself has any estate or interest in the land other than as set out in Schedule 2; There is no p erson in possession or o ccupat ion of the land adv ersely to th is claim and the land is o ccup ied by the applicant / the persons set out in Schedule 2;

The applicant has never been bankrupt nor assigned his / her estate for the benefit of creditors. I make th is so lemn declarat ion conscient iously believ ing t he same to be t rue and by v irtue of the Oaths Act 1900 and I cert ify this app licat ion to be correct fo r the purposes of the Real Prop erty Act 1900. Made and subscribed at
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in the State of

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on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . in the presence of Signature of witness: ............ ....... ....... ........ ....... ..... Signature of applicant: Name of witness: Address of witness: Qualification of witness:
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! Justice of the Peace

! Practising Solicitor ! Other [specify] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

* As the Depart ment of Lands may not be able to provide the serv ices of a justice of the peace or other qualified witness, the statutory declaration should be signed and witnessed prior to lodg ment of the form at Land Property Information Division. A set of instruct ions fo r co mp let ing th is fo rm is availab le fro m the Depart ment of Lands, Land and Prop erty In fo rmat ion Div is ion .

AL L

H A N D W R IT IN G M U S T BE IN B L O C K C A P IT A L S .

Pa g e 1 o f

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S C H E D U L E 1 (doc ume nts r efe rre d t o i n cla use 1 o f dec la r ati on) No. Nature of Document Date of Docu ment Part ies

S C H E D U L E 2 (doc ume nts r e fe rr e d t o i n cl a use s 2 a nd 3 o f decl a ra ti on) Full Name and Address of Occupier, Lessee, Mortgagee, etc Nature of Entitlement Particulars of instrument (if any) by which entitlement was created

P age 2 of