QUEENSLAND TITLES REGISTRY	SURRENDER OF HIGH-DENSITY	FORM 40 Version 1

Land Title Act 1994	DEVELOPMENT EASEMENT	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 High-density Development Easement being surrendered	Lodger (Name, address, email & phone number)	Lodger Code (if any)
2. Lot on Plan Descriptions of Affected Land	Title Reference
3. Registered Owners
4. Surrender/Execution * Surrender The registered owners surrender the High-density Development Easement in item 1 so that the High-density Development Easement is extinguished.
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 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 Registered Owner’s Signature (Witnessing officer must be in accordance with Schedule 1 of Land Title Act 1994 eg Legal Practitioner, JP, C Dec)