QUEENSLAND TITLES REGISTRY	SURRENDER OF EASEMENT	FORM 10 Version 4

Land Title Act 1994 and Land Act 1994	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 Titles Queensland website.
1. Dealing number of easement being surrendered	Lodger (Name, address, E-mail & phone number)	Lodger Code
2. Description of Easement/Lot on Plan Servient Tenement (burdened land)	Title Reference
*Dominant Tenement (benefited land) * not applicable if easement in gross
3. Grantor	4. Grantee
5. Surrender/Execution *Full Surrender The Grantee surrenders the easement in item 1 so that the easement is extinguished. *Partial Surrender The Grantee surrenders the easement in item 1 so that the easement is extinguished so far as the easement relates to:- *part of the Dominant Tenement; or *part of the Servient Tenement. * 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 Grantee’s Signature (Witnessing officer must be in accordance with Schedule 1 of Land Title Act 1994 eg Legal Practitioner, JP, C Dec) signature full name qualification / / Witnessing Officer Execution Date Grantor’s Signature (Witnessing officer must be in accordance with Schedule 1 of Land Title Act 1994 eg Legal Practitioner, JP, C Dec)