Development Application Part 1 of 2 Application Form MCU12/0047

QUEENSLAND LAND ~EGISTRY                        PROPERTY INFORMATION (TRANSFER)                                                           FORM 24 Version 5

                   (Thisform must accompany Land Registry Form 1                     -
                                                                                       Transfer when lodged In the Land Registry)
 Dulles Ac12001; Land Valuallon Acl2010, Land Tax Acl2010, Local Governmenl Act 2009, Wa/er Act 2000, ElectrIcal Safety Act 2002, Fir!! and Rescue S!!rvlce Acl1990
                                           South-Easl Queansland Wa/er (Dlslrlbullon and Retail Restructuring) Acl2009


PART A        -
                 Transferee to complete                                                      Title reference       15735214                         Page 1 of 2

r                                                                                                                                                                I
 Printed version   - this form must be printed and then                                                  Official use only
completed by hand.
Where insufficient space in an item, use Form 20
                                                                                                            11111111.11111111
(Enlarged Panel).
 Mark appropriate [ )with ’X’

 Refer to guide for completion for further information.


1.    Transferee
(a) Given names & surname                                               (b)Date of birth (0) Residential or business address
    or Company & ACN/ABN                                                   (ddfmmlyyyy)      after posseSSion                        .




                                                                                                    Po ~o.><. lqb                                      Vl   :
                                                                                                                                                                ?)1g4L(-
Jacaranda No 12 Pty Ltd ACN 154885702
                                                                                                                              ;T(’()if~
(d) Contact details after possession
    (i) Phone number 04Oc2.0 18..Jto
                                -




    (ii) Postal address As above [Xl QB complete address below
                                 -




         PO Box 1968, Traralgon Vie 3844


(e) Name of trust       -   N/A [    ]OR complete       -   Jacaranda No. 12 Unit Trust

(f)   Is transferee a foreign person 1 corporation?                         N/A [          NO [X I        YES [ ))>          Attach completed Form 25
                                                                                                                             (Foreign Ownership Information)
(g) Does transferee ordinarily reside in Australia?                         N/A [          NO [      )    YES [ X      )


2.    Transaction

(a) Date of possession .(dd/mm/yyyy)           -   28/02/2012                            )> The dale of possession Is the aclual date the transferee has
                                                                                            legal conlrol or ownership of the property. Usually, this is the
                                                                                            date ofsettlement, or the date as agreed to by both parties.

(b) Date of settlement (dd/mmlyyyy)           -    28102/2012                            )> The dale of settlement must be completed even where It Is the
                                                                                                                                                   .




                                                                                             same as the date of   possession.




 Information from this form Is collecled and used under the authority of legislation staled at the top of this form. It Is provided to aid Govemmenl
 departments, local authorities and Water distribution entities. Some Information may be Included in publicly searchable records maintained by those
 agencies. Information from the Valuation & Sales database may be provided to data brokers who may sell It as part of an Information package.
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