Lodging Party (Insert Name)

RV
Form 084

APPLICATION TO VARY RESTRICTIONS

PRIVACY COLLECTION STATEMENT (PRIVACY ACT 1988 (C’WLTH)) OVERLEAF

The applicant/s may make application to vary the restrictions relating to item 1.	

1. LAND
Vol:Fol	Edition	District/Division	Section	Block	Unit	
     	     	     	     	     	     	

2. APPLICANT/S

     

3. DETAILS OF THE VARIATION OF RESTRICTIONS  (Tick appropriate box or provide details of the variation)

 Section 180 Land Act 1991 – Compliance Certificate Issued

 Section 298 Planning and Development Act 2007 – Compliance Certificate Issued

 Restrictive Covenant Created by T      

 S. 20 Unit Titles Act 2001 - Subject to a Staged Development Approval - Released By ALUP -      

 Other (specify) -      

5. DATE

     
	
6. EXECUTION
Signature of applicant/s

Printed Full Name of applicant/s		Signature of witness

     

Printed Full Name of witness	

7. LAND TITLES USE ONLY
Lodged by	 	Vol:Fol:Ed/Production No.
(if applicable)		
Data Entered by		Certificates Lodged
(Compliance/Occupancy)		
		Attachments/Annexures		
Registered by		Registration Date		

PRIVACY STATEMENT
S.43 of the Land Titles Act 1925 (LTA) authorises the Registrar-General to collect the information required by this form for the establishment and maintenance of the Land Titles Register.  S.65-67 LTA requires that the Register be made available to any person for search, upon payment of a fee. The information is regularly provided to various ACT Government agencies, including Territory and Municipal Services, ACT Planning and Land Authority (the Authority), ACT Treasury, Canberra Connect and ActewAGL for conveyancing, municipal account, administrative, statistical and valuation purposes.  The Authority and agencies within Territory and Municipal Services may also use the information supplied to prepare and sell property sales reports to commercial organisations concerned with the development, sale or marketing of land.  	

SCHEDULE OF NOTES
•	This form is to be used to vary the restrictions on a Crown Lease.
•	Documents must be typed, or completed in black ink or biro.
•	Alterations to information entered on the form should be made by crossing out (not erasing or obliterating by painting over) and should be initialled by all parties.
•	If there is insufficient space in any panel use an annexure sheet.
•	Volume, Folio and Edition references must be given.  
•	Execution by
•	A Natural Person – should be witnessed by an adult person who is not a party to the document.
•	Attorney – if this document is executed by an Attorney pursuant to a registered power of attorney, it must set out the full name of the attorney and the form of execution must indicate the source of his/her authority eg. “AB by his/her attorney XY pursuant to Power of Attorney ACT Registration No… of which he/she has no notice of revocation”.
•	Corporation – Section 127 of the Corporations Act provides that a company may validly execute a document with or without using a Common Seal if the document is signed by:

a.	Two directors of the company;
b.	A director and a secretary of the company; or
c.	Where the company is a proprietary company and has a sole director who is also the sole company secretary, that director.   Please identify that the director is a sole director on the form.
The following forms of execution are suggested –
With A Common Seal
The Common Seal of ABC Pty Ltd/Ltd ACN…
was affixed in the presence of-
...................................(signature)	
...................................(director/secretary)*
(*repeat if necessary i.e. if two directors signing.  If signing as sole director and sole secretary, state ‘director/secretary’) 
Without A Common Seal
Signed by………Pty Ltd/Ltd ACN…
...................................(signature)	
...................................(director/secretary)*
(*repeat if necessary  i.e. if two directors signing.  If signing as sole director and sole secretary, state ‘director/secretary’) 

NB	The normal witnessing provisions in the Land Titles Act 1925 do not apply to execution by a corporation as above, but do apply to execution by the attorney of a corporation.