QUEENSLAND TITLES REGISTRY	EASEMENT	FORM 9 Version 4

Land Title Act 1994 and Land Act 1994	Duty Imprint	Page 1 of [Total]

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. Grantor	Lodger (Name, address, E-mail & phone number)	Lodger Code
2. Description of Easement/Lot on Plan Servient Tenement (burdened land)	Title Reference
#Dominant Tenement (benefited land) # insert “Not applicable” if easement in gross
3. Interest being burdened	#4. Interest being benefited # insert “Not applicable” if easement in gross
5. Grantee Given names	Surname/Company name and number	(include tenancy if more than one)
6. Consideration	7. Purpose of easement

8.	Grant/Execution

The Grantor for the above consideration grants to the Grantee the easement over the servient tenement for the purpose stated in item 7 and the Grantor and Grantee covenant with each other in terms of:- *the attached schedule; *the attached schedule and document no. ; *document no.

* delete if not applicable

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	Grantor’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	Grantee’s Signature

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