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TRANSMISSION APPLICATIONBY PERSONAL REPRESENTATIVES

F o r m A 1

* NB : A penal t y o f u p to $2 000 o r 6 mon ths imp risonme nt applie s fo r imp roper witn e ssing Guidance Notes available

C E R T IFI C A T E (S ) O F T I T L E A F F E C T E D

E S T A T E A N D I N T E R E S T

D E C E A S E D P R O P R IE T O R ( F u ll n a m e )

( a )

w h oi s o n ea n dt h es a m e p ers o n a s t h er e gis te r e dpr o pr i eto r o ft h ee s t a t e a ndi nter e sta n di s n a m e d a ndd esc r ib e di n th eR e gis t er B o ok a s :

( b)

A P P L I C A N T ( F u l ln a m e a n d a d d r e s s )

T H E A P P L IC A N T A S P E R S O N A L R E P R E S E N T A T IV E O F T H E A B O V E N A M E D D E C E A S E D P R O P R IE T O R A P P L I E S T O B E R E G IS T E R E D A S T H E P R O P R IE T O R O F T H E E S T A T E A N D I N T E R E S T O F T H E S A I D D E C E A S E D I N T H EL A N D A B O V E D E S C R I B E D .

D A TE D

E X E C U TI

O N

.........................................................................................................S i g n a t u re of A P P L I C A N T

.........................................................................................................Si g n at ur e of W IT N E S S Signed in my presence by the APPLICANT whois either personally known to me or has satisfied me as to his or her identity. *

.........................................................................................................P r in t F u ll N a m e o f W it n e ss ( B L O C K L E T T E R S )

.........................................................................................................

.........................................................................................................A d d r e ss o f W i t n es s

B u s i n es s H o u r s T e l e p h o n e N o . .......................................................

.........................................................................................................S i g n a t u re of A P P L I C A N T

.........................................................................................................Signature of WITNESS Signed in my presence by the APPLICANT who iseither personally known to me or has satisf ied me as to his or her identity. *

.........................................................................................................P r in t F u ll N a m e o f W it n e ss ( B L O C K L E T T E R S )

.........................................................................................................

.........................................................................................................A d d r e ss o f W i t n es s

B u s i n es s H o u r s T e l e p h o n e N o . .......................................................

Volume Folio

8/2/2019 A1 Transmission Application

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L A N D S TITL E S R E G IS T R A TI O N

O F F I C E S O U T H A U ST R A LIA

TRANSMISSION APPLICATION

BY PERSONAL REPRESENTATIVES

F OR M A P P R O V E D B Y T H E R E G IST R A R - G E N E R A L

B E L O W T H IS L I N E F O R O F F I C E & S T A M P D U T Y P U R P O S E S O N L Y

B E L O W T H IS L I N E F O R A G E N T U S E O N L Y

A G E N T C O D E

Lodged by:

Correction to :

T IT L E S, C R O W N L E A S E S, D EC L A R AT I O N S E TC . L O D G E D W IT H

IN S T R U M E N T (T O B E F I L L E D IN B Y P E R S O N L O D GI N G )

1 . ...............................................................................................................

2 . ...............................................................................................................

3 . ...............................................................................................................

4 ................................................................................................................

P L E A S E I S S U E N E W C E R TI F I C A T E ( S )O F TIT L E A S F O L L O W S

1 . ...............................................................................................................

2 . ...............................................................................................................

3 ................................................................................................................

4 ...............................................................................................................

DELIVERY INSTRUCTIONS ( A g e nt to co m pl et e )P L E A S E D E LI V ER T H E F O L L O W IN G IT E M ( S )T O T H E U N D E R M E N T I ON E D A G E N T ( S )

R-G 250505

ITEM(S) AGENT CODE

C O R RE C T IO N P A S S E D

R E G IS TE R E D

R E G IS T RA R - G E N E RA L

P R O B AT E/ R E G IS TR A R SC ER T IF I C AT E E X A M I N E D

C ER TI F I E D C O R R E C TF O R T H E P U R P O S E SO F T H E R E A L P R O P E R T Y A C T 18 8 6

S olic it o r/R e gist e r ed C o nv e y a nc e r/ A pp lic a nt

Prefix

T A

Series No.