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

DETERMINATION/SURRENDER  
OF A CROWN LEASE	
Form 057 - DCL	

	Land Titles Act 1925	
IMPORTANT INFORMATION
This form is to be used to lodge a determination/surrender of a crown lease 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 Seller Verification Declaration must be completed prior to lodgement of this form.  The submission date and reference number must be recorded on this form.
•	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.
•	The first named buyer on this form will be the primary contact for ACT Revenue Office purposes.
•	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.  If there is insufficient space in any panel, please use an Annexure Sheet.
•	Execution by:
a)	A Natural Person – Should be witnessed by an adult person who is not a party to the document.
b)	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 e.g. “AB by his/her attorney XY pursuant to Power of Attorney ACT Registration No…… of which he/she has no notice of revocation”. (This execution requires a witness).
c)	Corporation – Section 127 of the Corporations Act provides that a company may now validly execute a document with or without using a Common Seal if the document is signed by:
i.	Two directors of the company;
ii.	A director and a secretary of the company; or
Where the company is a proprietary company and has a sole director who is also the sole company secretary, that director.  (This execution does not require a witness).	

LODGEMENT AND CONTACT INFORMATION	

Website:
www.accesscanberra.act.gov.au

General Enquiries: 
13 22 81
	
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

DETERMINATION/SURRENDER  
OF A CROWN LEASE	
Form 057 - DCL	

	Land Titles Act 1925	
LODGING PARTY DETAILS	
Name	Email Address	Contact Telephone Number	
     	     	     	

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

REPRESENTING SOLICITOR DETAILS FOR SELLER (Complete if applicable – otherwise state below “Not Applicable”)	
Name of Firm	Solicitor Email Address	Solicitor Name	
     	     	     	

THE SELLER VERIFICATION DECLARATION HAS BEEN SUBMITTED (must be completed prior to lodgement of this document)	
 Yes – (provide date and reference number, if there are multiple submissions provide details for all)
Submission Date:                                                              Reference Code:	

FULL NAME AND ADDRESS OF REGISTERED PROPRIETOR/LESSEE (Surname Last) (ACN required for all Companies)	
     	

CONSIDERATION (Please provide monetary sum and/or reason for surrender)	
     	

DEVELOPMENT STATUS (Tick the appropriate box – one box must be completed)	
 Land Only                          or                              Incomplete Building                    or                            Building Completed 	

LAND USE (Tick the appropriate box – one box must be completed)	
 Residential                        or                             Commercial                                  or                            Rural 	

CONSENTING PARTY – SUPPORTING DOCUMENTATION
(One form required for each party required to consent)	
 Please complete and attach – Form 042 – C – Consent	

DATE	
     	

LESSEE/S EXECUTION	

Print full name of Lessee

     

Signature or common seal of Lessee
	
Print full name and address of witness

     

Signature of witness 

LESSOR’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 / Annexures		
Registration date		Vol & Folio of further lease