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

DECLARATION BY EXECUTOR ON A MORTGAGE	
Form 071 - DEXM	

	Land Titles Act 1925	
IMPORTANT INFORMATION
This form is to be used to lodge a declaration by executor on a mortgage 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
•	Original probate or letters of administration or certified true copy of original must be supplied with lodgement of this form.  The transmission application must have been lodged prior to lodgement of this document.
•	The certificate of title is not required for lodgement of this document.
•	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.  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
iii.	Where the company is a proprietary company and has a sole director who is also the sole company secretary, that director. (No witness is required for this execution).
•	The following forms of execution are suggested –
a)	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’) - (No witness is required for this execution).
b)	Without A Common Seal
Signed by ABC 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’) - (No witness is required for this execution).
	
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

DECLARATION BY EXECUTOR ON A MORTGAGE	
Form 071 - DEXM	

	Land Titles Act 1925	

This form can only be used when the executor and the beneficiary are the same.  If both the executor and the beneficiary are not one and the same, then a transfer form should be used.  Note – This is not a dutiable document.

LODGING PARTY DETAILS	
Name	Postal Address	Contact Telephone Number	
     	     	     	

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

REGISTERED MORTGAGE NUMBER (Associated Dealing Number)	
     	

NAME OF THE MORTGAGEE / PROPRIETOR OF MORTGAGE
(Surname Last)  - (ACN required for all companies)	FULL POSTAL ADDRESS including post code (after transfer)	
     	     	

FORM OF TENANCY (this cannot differ from probate)	
Joint Tenants  /  Tenants in Common (in the following  shares) - 	

ENTITLEMENT 	
Entitled as - Beneficiary	

SUPPORTING DOCUMENTATION (delete whichever is not applicable)	

Pursuant to:            Probate            Letters of Administration            Sequestration Order           Other – Please specify       

     
Number	
     
Granted on (date)	
     
Granted to:	

 
ESTATE OR INTEREST (whole or state share)	RESTRICTIVE COVENANTS 
(Complete if applicable otherwise state below “Not Applicable”)	
     	     	

STATUTORY DECLARATION	

I,                                                                        of                                                                                                         , 

                                                                        (occupation)

I/We declare that all executorial duties and responsibilities in respect to the land have been duly performed and I/we have ceased to hold the land as executor/s and that I/we hold the land as beneficiaries.

And I make this solemn declaration by virtue of the Statutory Declarations Act 1959, and subject to the penalties provided by that Act for the making of false declarations, conscientiously believing the statements contain in this declaration to be true in every particular.

STATUTORY DECLARATION EXECUTION	

Declared at                                                                             on

the                        day of                                                        20

Signature of person making the declaration	Signature of person before whom the declaration is made

     

Full name, qualification* and address of person before whom the declaration is made (in printed letters) (*Must be authorised under the Statutory Declarations Act 1959)	

EXECUTION	

Print full name of the registered proprietor/s

     

Signature of the registered proprietor/s

Dated -      	
Print full name and address of witness 

     

Signature of witness

Dated -      	

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