QUEENSLAND TITLES REGISTRY	PLAN COVER SHEET	FORM 21Z Version 3

Land Title Act 1994 and Land Act 1994

Dealing Number	Lodger (Name, postal address, E-mail & phone number)	Lodger
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. Print one-sided only	Code
1. Plan Number	Title References
2. No of New Lots No of Public Use Lots No of Secondary Interests (e.g. Easements)
3. Directive Worksheet OFFICE USE ONLY Encumbrances: Lots: Plan Examination Checklist Dealing Notes Form 18 Mortgagee Consent Form 18A Registered Owner Form 18B Planning Body Approval Fees checked Plan amendments to original and certified by Surveyor Associated Dealings: All requisitions complete Data entry New Title directives Public Use Land Park Road Examination/Requisition Notes