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Fillable Printable Request to Register or Revocation Power of Attorney

Fillable Printable Request to Register or Revocation Power of Attorney

Request to Register or Revocation Power of Attorney

Request to Register or Revocation Power of Attorney

QUEENSLAND TITLESREGISTRY
REQUEST TO REGISTER POWER OF ATTORNEY/
Land Title Act 1994 and Land Act 1994 REVOCATION OF POWER OF ATTORNEY
Dealing Number
Lodger(
Name, address & phone number)
OFFICE USE ONLY
Privacy Statement
Collection of information from this form is authorised by legislation and
is us
ed to maintain publicly searchable records. For more information
see the Department’s website.
FORM 16 Version 4
Page 1 of
Lodger
Code
1.
Principal (Donor)
Given names
Surname/Co
mpany name and number
2. Attorney (Donee) Given names
Surname/Company name and number
3.Request
It is requested that you register:
4.
Executio
n
/ / .............................................................
Executio
n Date Applicant's or Solicitor's Signature
Note: A Solicitor is required to print full name if signing on behalf of the Applicant
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