LAND TITLES
ACCESS CANBERRA
Chief Minister, Treasury and Economic Development Directorate

CONCESSIONAL LEASE NOTIFICATION	
Form 097 - CLN	

	Land Titles Act 1925	

IMPORTANT INFORMATION

This form is to be used to lodge a concessional lease notification under the Land Titles Act 1925 (the Act).  You can access the Act at www.legislation.act.gov.au.  You may also obtain further information and forms at www.act.gov.au/accesscbr.

PRIVACY INFORMATION

The Act authorises the Registrar-General to collect the personal information required by this form for the purposes of issuing a registration under the Act.  The Registrar-General prevents any unreasonable intrusion into a person’s privacy in accordance with the Information Privacy Act 2014. The Registrar-General provides identifiable information to law enforcement and other Directorates that have legal authority to request information under prescribed circumstances.
These agencies may also use this information to prepare and sell property sales reports to commercial organisations concerned with the development, sale or marketing of land.

INSTRUCTIONS FOR COMPLETION

•	The certificate of title or production of title consenting to the registration of this document is required for lodgement.
•	All information should be typed or clearly printed.  If completing this form by hand please use a solid black pen only.  
•	This office will not accept lodgement of this form if it is not completed in full.
•	Any alteration to information provided on this form must be struck through with a black pen.  Substitute information must be clear and all parties must sign in the margin.  Do not use correction fluid or tape.
•	Ensure all required documents are attached. 
•	Execution by:
a)	A Natural Person – Should be witnessed by an adult person who is not a party to the document.

LODGEMENT AND CONTACT INFORMATION

Email:
actlandtitles@act.gov.au
General Enquiries: 
(02) 6207 3000 
	
In Person:
Environment, Planning and Land Shopfront
Ground Floor South, Dame Pattie Menzies House, 16 Challis Street, Dickson
Opening hours - Monday to Friday 8:30am to 4:30pm (excluding public holidays)	

	LAND TITLES
ACCESS CANBERRA
Chief Minister, Treasury and Economic Development Directorate

CONCESSIONAL LEASE NOTIFICATION	
Form 097 - CLN	

	Land Titles Act 1925	

LODGING PARTY DETAILS	
Name	Postal Address	Contact Telephone Number	
     	     	     	

TITLE AND LAND DETAILS	
Volume & Folio	District/Division	Section	Block	
     	     	     	     	

FULL NAME AND POSTAL ADDRESS OF REGISTERED PROPRIETOR/S (Surname Last) (ACN required for all companies)	
     	

ACTPLA DECISION	DATE	
 Please attach copy of ACTPLA Decision notice		

ACTPLA’S EXECUTION	

Signed by the person duly authorised by ACT Planning and Land Authority (Please print full name of authorised signatory).

     

Signature of authorised person
	
Print full name and address of witness

     

Signature of witness 

OFFICE USE ONLY	
Lodged by		Certificate of title lodged		
Data entered by		Certificates attached to title		
Registered by		Attachments / Annexure		
Registration date		Production number