AF 13.1 last updated 01/07/13
CERTIFICATE IMPOSING CONDITION
UNDER SECTION 75(2) OF THE BUILDING ACT 2004
Section 77(1) and (4) Building Act 2004
Land Registration District(s)
Specified Allotments Continue on Annexure Schedule, if required
Unique identifier(s) of
Other Specified Allotment(s) to be
included in any Transfer or Lease
Name of Territorial Authority
Queenstown Lakes District Council
Full Name of Registered Proprietor Surname to be underlined
Certificate
A Building Consent is to be granted, subject to a condition under section 75 of the
Building Act 2004, that the specified allotments must not be transferred or leased
except in conjunction with (the) other allotment(s), as set out in the above table.
day of 20
Signature (Territorial Authority)
Signed by*
*Insert name and designation of signatory in BLOCK letters (unless legibly printed):
A duly authorised Officer of the Territorial Authority
Signature (Registered Proprietor)