10-0530
Office use only
LAND AND PROPERTY INFORMATION New South Wales
1 Prince Albert Road, Queens Square, Sydney 2000
Telephone 02 9228 6877
Do not affix additional pages here
use the left-hand corner
DEEDS INDEX
PARTICULARS
CA NUMBER
PRIVACY NOTE: this information is legally required and will become part of the public record
(A)
Delivery Box
Name, Address/DX
Telephone no
Reference
(B)
Nature of Instrument
Date of Instrument
(C)
Leave blank where instrument does not affect old system land
Locality of the land
LINK CONVEYANCE-for old system land
Book
LOCAL GOVT. AREA
PARISH
Number
PRINCIPAL DEED
Whole/Part
COUNTY
NOTING
[Office use
only]
(D)
(E)
Entry
GIVEN NAMES/COMPANY NAME
FAMILY NAME
I,......................................................................................... of ..................................................................................
...................................................................................................................................................................................
certify that for the purposes of section 184D(3) of the Conveyancing Act 1919 that:
1. the registration copy is a true copy of the original and
2. the above index particulars of the original instrument [and on the annexure(s)] are complete and
correct.
Signed ............................................................................................................... Date ................................................
Entered:
Verified: