ACT REVENUE OFFICE
PO Box 293 Civic Square ACT 2608
Phone:    (02) 6207 0028
Fax:        (02) 6207 0026
Website: www.revenue.act.gov.au

Lodgment No

Declaration for Residential ‘Off the Plan’ Purchase Agreement Form
NOTE:
•	This form must be completed and lodged with a completed Conveyance Lodgment Form (and relevant documents) for stamping a residential ‘off the plan’ purchase agreement under section 16A of the Duties Act 1999.
•	Print clearly in the boxed spaces and tick the appropriate box

Date of
First
Execution	                                            Names of Parties

Transferor                                                          Transferee	

Suburb	Section	Block	Unit	

I am lodging this form because:

             /                 /

 the agreement was completed on		         Date           

             /                 /

 the whole, or any part, of the tranferee’s 
 interest under the agreement was assigned on         Date

             /                 /

	     the period of 12 months, beginning from the
	     date of the agreement expired on                           Date
     
     a Certificate of Occupancy for the building

Date

             /                 /

     to which the agreement relates was issued
     under the relevant ACT legislation on

             /                /             

     I wish to lodge the documents on a date prior to 					
     any of the above events occurring.                         Date

  	DECLARATION

I ……………………………………………………………….…of…………………………………………………………………………

  being the transferee/transferee’s authorised agent (delete whichever is not applicable) declare that the above information is, to the best of my knowledge, true and correct and in conformity with the agreement between the parties.

Signed ____________________________________	Date                                  

GIVING FALSE OR MISLEADING INFORMATION IS A SERIOUS OFFENCE (Section 338 Criminal Code 2002)
This form is Approved form AF2006-67 under section 139C of the Taxation Administration Act 1999