ATTCH 5 - IR Response - Covenants (Anderssen Lawyers) (1)

QUEENSLAND TITLES REGISTRY                                                                EASEMENT                                                                FORM 9 Version 4
Land Title Act 1994 and Land Act 1994                                                                                                Duty Imprint                    Page 1 of 8

                                         Dealing Number


                                      OFFICE USE ONLY
Privacy Statement
Collection of information from this form is authorised by legislation and is
used to maintain publicly searchable records. For more information see
the Department’s website.
1.     Grantor                                                                                 Lodger (Name, address, E-mail & phone number)                             Lodger
                                                                                                                                                                         Code




2.     Description of Easement/Lot on Plan                                                                                                                    Title Reference
       Servient Tenement (burdened land)
       See Enlarged Panel
       #Dominant Tenement (benefited land)

       See Enlarged Panel
# not applicable if easement in gross


3.     Interest being burdened                                                               #4.    Interest being benefited
       FEE SIMPLE                                                                                   FEE SIMPLE
                                                                                             # not applicable if easement in gross

5.     Grantee           Given names                                           Surname/Company name and number                             (include tenancy if more than one)



6.     Consideration                                                                         7.     Purpose of easement
       $1.00                                                                                        ACCESS
8.     Grant/Execution
The Grantor for the above consideration grants to the Grantee the easement over the servient tenement for the purpose stated in item
7 and the Grantor and Grantee covenant with each other in terms of:- *the attached schedule; *the attached schedule and document
no.       ; *document no.
* delete if not applicable
                    Witnessing officer must be aware of his/her obligations under section 162 of the Land Title Act 1994


..............................................................................signature

..............................................................................full name

…………………………………………. ....................qualification                                                 /   /                    ...................................................................
Witnessing Officer                                                                             Execution Date                                                 Grantor’s Signature
(Witnessing officer must be in accordance with Schedule 1
of Land Title Act 1994 eg Legal Practitioner, JP, C Dec)


..............................................................................signature

..............................................................................full name

…………………………………………. ....................qualification                                                    /   /                 ...................................................................
Witnessing Officer                                                                                 Execution Date                                             Grantee’s Signature
(Witnessing officer must be in accordance with Schedule 1
      of Land Title Act 1994 eg Legal Practitioner, JP, C Dec)