QUEENSLAND TITLES REGISTRY	RELEASE OF MORTGAGE	FORM 3 Version 4

Land Title Act 1994, Land Act 1994 and Water Act 2000	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.	X If partial release of the mortgage. Mortgagee’s Australian Credit Licence (if any)
1. Dealing number of mortgage being released	Lodger (Name, address, E-mail & phone number)	Lodger Code
2. Lot on Plan Description	Title Reference
3. Mortgagor # Only complete if not releasing the debt for all mortgagors
4. Mortgagee
5. Discharge/Execution by Mortgagee The Mortgagee releases the mortgage as a charge on the land described in item 2.
Witnessing officer must be aware of his/her obligations under section 162 of the Land Title Act 1994

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Witnessing Officer (signature, full name & qualification)	Execution Date	Mortgagee's Signature

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Witnessing Officer (signature, full name & qualification)	Execution Date	Mortgagee's Signature

(Witnessing officer must be in accordance with Schedule 1
of Land Title Act 1994 eg Legal Practitioner, JP, C Dec)