QUEENSLAND TITLES REGISTRY	TRANSMISSION APPLICATION BY PERSONAL	FORM 5A Version 8

Land Title Act 1994, Land Act 1994 and Water Act 2000	REPRESENTATIVE (No Grant in Queensland or	Page 1 of [Total]

no Queensland recognised grant**)

Dealing Number	Lodger (Name, address, email & phone number)	Lodger Code
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	(if any)
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
Postal address of the applicant: (for service of notices, including rates)
5. Document(s) deposited *Original last will ) *Office copy of Death Certificate issued by the Registry of Births, Deaths & ) Marriages (Qld) or equivalent evidence from another state or country ) of the deceased ) * 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. Transmission applications by a personal representative, with a Grant in Queensland or a Queensland recognised grant, are to be on a Form 5.
6. Request In accordance with the particulars disclosed in the attached declaration, it is requested that the applicant be registered as proprietor of the above interest in the land as personal representative. Witnessing officer must be aware of his/her obligations under section 162 of the Land Title Act 1994 Separate executions are required for each applicant. Signatories are to provide to the witness, evidence that they are the person entitled to sign the instrument (including proof of identity).

signature

full name

qualification	/ /

Witnessing Officer	Execution Date	Applicant’s or Solicitor’s Signature

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

DECLARATION BY APPLICANT	ANNEXURE TO FORM 5A

Page 2 of [Total]

I,

of

in the State of

do solemnly and sincerely declare that:

1.	The applicant is or is entitled to be the personal representative of the deceased because:

*	the applicant is the executor of the last will of the deceased.

*	(if other, state basis of entitlement)

2.	I have caused a search to be made and find that no grant of administration of the estate of the deceased (including a reseal) has been made, applied for, or caveated against in Queensland.

If a will

3.	*(a)	The deceased did not marry on or after the date of execution of the will.

*(b)	The deceased married me on or after the date of execution of the will however, our marriage was solemnised on or after 1 April 2006 and I was married to the deceased at the time of his/her death.

*(c)	The deceased did not enter into a civil partnership on or after the date of execution of the will.

*(d)	The deceased did enter into a civil partnership with me on or after the date of execution of the will and I was in a civil partnership with the deceased at the time of his/her death.

If a will and applicant is surviving husband or wife of the deceased

4.	*The marriage between the deceased and me had not been dissolved nor had any proceedings for annulment been commenced.

If a will and marriage between applicant and deceased has been dissolved/annulled

5.	*The marriage between the deceased and me was dissolved/annulled on or after 1 April 2006 however, by the deceased’s will the deceased expressed an intention that my appointment as executor not be revoked.

If a will and applicant is the survivor of a civil partnership with the deceased

6	*The civil partnership between the deceased and me had not been terminated nor found to be void under the Civil Partnerships Act 2011 sections 18 or 30 respectively.

If a will and a civil partnership between the applicant and deceased has been terminated or is void

*The civil partnership between the deceased and me was terminated or was found to be void under the Civil Partnerships Act 2011 sections 18 or 30 respectively, however by the deceased’s will the deceased expressed an intention that my appointment as executor would not be revoked.

If a will and deceased died on or after 5 June 2017 and applicant is surviving de facto partner

8.	*The de facto relationship between the deceased and me had not ended.

If a will and deceased died on or after 5 June 2017 and de facto relationship between the applicant and deceased had ended

9.	*The de facto relationship between the deceased and me had ended, however by the deceased’s will the deceased expressed an intention that my appointment as executor would not be revoked.

If deceased died intestate

10.	*The deceased died intestate and his/her gross estate in Queensland at the date of death did not exceed $300,000.

*rule through if not applicable

AND I make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions of the Oaths Act 1867 (Qld).#

#	The form of wording should comply with the appropriate Oaths/Evidence Act under which the declaration is being made. Note a declaration under the Oaths Act 1867 (Qld) can only be taken by the persons listed in section 13 of that Act.

signature

full name

qualification	/ /

Witness as authorised under the relevant Oaths/Evidence Act	Execution Date	Applicant's Signature

signature

full name

qualification	/ /

Witness as authorised under the relevant Oaths/Evidence Act	Execution Date	Applicant's Signature