Application to Revert to
Maiden Name
Section 160(4) Land Titles Act 1980.
DESCRIPTION OF LAND
Folio of the Register
Folio
Volume
Volume
<<Buy|Enquiry
Information|FromExisting|Vol
ume>>
Folio
<<Buy|Enquiry
Information|FromE
xisting|Folio>>
of ....................................................................................................................................................................
<<Buy|Client|Physical Address>>
being registered in my former name of
<<Buy|Name Changes|oldName>>
.......................................................................................................................................................................
as proprietor of an estate in fee simple in the land comprised in the above folio(s) of the Register and having
renounced and abandoned my former name and reverted to my maiden name:
<<Buy|Name Changes|newName>>
.......................................................................................................................................................................
hereby apply to have this change of name noted on the above folio(s) of the Register
Date: ............................................
Signed by the Applicant
Signed: .........................................
Witness: .........................................
.........................................
.........................................
.........................................
(signature, name, occupation & full postal address)
RN
Version 1 (TOLD)
THE B ACK OF THIS FORM MUS T NOT B E US ED
Created 30-Dec-2006 06:57PM
.............................................................
Folio of the Register Reference:
(First reference stated on accompanying dealing)
Vol.<<Buy|Enquiry
............................. Fol. <<Buy|Enquiry
...........
Information|FromE
xisting|Volume>>
Full Address of
Information|Fro
mExisting|Folio
Transferor/Vendor
>>
Particulars of Sale
Chattels: $............................
Goodwill: $............................
Land Purchased/Acquired is
Whole
Part
<<Buy|Settlement|Dat
YES
NO
By selecting YES to this question, you are stating that this property is to be used by the transferee/purchaser as their principal place of residence as at 1st July
following settlement. This means that the property will not be subject to land tax. By selecting NO to this question, you are stating that this property is not to be used
by the transferee/purchaser as their principal place of residence and therefore may be subject to land tax. Note: The owner must notify the Commissioner of State
Revenue in writing within 30 days of the property ceasing to be used as their principal place of residence.
.............................................................
Dimensions/Area
.............................................................
It is hereby declared that the information contained herein is true and correct.
Name & Signature of Person giving Notice:
.............................................................
.............................................................