QUEENSLAND TITLES REGISTRY	EXTINGUISHMENT OF	FORM 34 Version 3

Land Title Act 1994 and Land Act 1994	BUILDING MANAGEMENT STATEMENT	Page 1 of 1

Dealing Number	Lodger (Name, 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.	Code
1. Dealing number of instrument/document being extinguished
2. Lot on Plan Description of affected land	Title Reference
3. Registered Owners/State Lessees
4. Execution The Registered Owners/State Lessees identified in item 3 agree to the extinguishment of the building management statement in item 1. 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 Registered Owner's/ (Witnessing officer must be in accordance with Schedule 1 State Lessee's Signature of Land Title Act 1994 eg Legal Practitioner, JP, C Dec) signature full name qualification / / Witnessing Officer Execution Date Registered Owner's/ (Witnessing officer must be in accordance with Schedule 1 State Lessee's Signature of Land Title Act 1994 eg Legal Practitioner, JP, C Dec)