QUEENSLAND TITLES REGISTRY	GENERAL REQUEST	FORM 14 Version 4

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 Titles Queensland website.
1. Nature of request	Lodger (Name, address, E-mail & phone number)	Lodger Code
2. Lot on Plan Description	Title Reference
3. Registered Proprietor/State Lessee
4. Interest
5. Applicant
6. Request I hereby request that:
7. Execution by applicant / / Execution Date Applicant's or Solicitor's Signature Note: A Solicitor is required to print full name if signing on behalf of the Applicant