QUEENSLAND TITLES REGISTRY	AMENDMENT	FORM 13 Version 7

Land Title Act 1994, Land Act 1994 and Water Act 2000	Duty Imprint	Page 1 of 1

Dealing Number
OFFICE USE ONLY Privacy Statement Collection of information from this form is authorised by legislation and is used to maintain publicly searchable records. For more information see the Department’s website. Print one-sided only	Mortgagee’s Australian Credit Licence (if any)
1. Type/Dealing No of Instrument/Document being amended Type of Instrument/Document Dealing Number	Lodger (Name, address, E-mail & phone number)	Lodger Code
2. Lot on Plan Description	Title Reference
3. Grantor/Mortgagor/Lessor/Covenantor
4. Grantee/Mortgagee/Lessee/Covenantee
5. Amendment of Lease Details (Both parts (a) AND (b) must be completed. Do not complete if amending covenants only.) (a) Expiry date (DD/MM/YYYY): / / AND/OR Event (if applicable): (b) Option/s#: # Insert NIL if no option or insert option period/s (e.g. 2 years or 2 x 3 years)

6.	Request/Execution

The parties identified in items 3 and 4 agree that the instrument/document in item 1 is amended in accordance with:- *item 5; *item 5 and attached schedule; *attached schedule.

* rule through or delete if not applicable

Witnessing officer must be aware of his/her obligations under section 162 of the Land Title Act 1994

Signature

full name

qualification	/ /

Witnessing Officer	Execution Date	Grantor’s/Mortgagor’s/Lessor’s/

(Witnessing officer must be in accordance with Schedule 1	Covenantor’s Signature
of Land Title Act 1994 e.g. Legal Practitioner JP, C Dec)

Signature

full name

qualification	/ /

Witnessing Officer	Execution Date	Grantee’s/Mortgagee’s/Lessee’s/

(Witnessing officer must be in accordance with Schedule 1	Covenantee’s Signature
of Land Title Act 1994 e.g. Legal Practitioner, JP,C Dec)