QUEENSLAND TITLES REGISTRY	TRANSMISSION APPLICATION BY	FORM 5 Version 7

Land Title Act 1994, Land Act 1994 and Water Act 2000	PERSONAL REPRESENTATIVE	Page 1 of [Total]

(Grant in Queensland or Queensland recognised grant**)

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. Print one-sided only	Code
1. Deceased's name
2. Lot on Plan Description	Title Reference
3. Interest held by deceased
4. Applicant Given Names	Surname/Company Name and ACN/ARBN
Address for service of notices to the applicant: (for rates purposes etc)
5. Document(s) deposited * Queensland Grant of Representation or Exemplification of Queensland Grant of Representation (Probate, Letters of Administration, Order or Election to administer, reseal of grant of representation) * Queensland recognised grant** or Exemplification of Queensland recognised grant** issued by the relevant authority (note declaration in item 6) * rule through/delete if not applicable ** a Queensland recognised grant is a grant of probate or letters of administration (within the meaning of the British Probates Act 1898) from any Australian state or territory, New Zealand or The United Kingdom of Great Britain and Northern Ireland.
6. Request / Declaration The applicant is the personal representative of the deceased and it is requested that the applicant be registered as proprietor of the above interest in the land as personal representative. Where the Transmission Application is made pursuant to a Queensland recognised grant or an Exemplification of a Queensland recognised grant – a search has been made that shows no Grant of Representation of the estate of the deceased (including a reseal) has been made, applied for, or caveated against in Queensland. Date of Queensland Court File Search: / / 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	Applicant’s or Solicitor’s Signature

(Witnessing officer must be in accordance with Schedule 1	Note: A Solicitor is required to print full name if signing on behalf

of Land Title Act 1994 e.g. Legal Practitioner, JP, C Dec)	of the Applicant and no witness is required in this instance