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Forms

Please select from the following:

  • Dampier to Bunbury Natural Gas Pipeline (DBNGP) corridor – application to carry out land use activities and works
  • Request for amendments to Crown land administration and registration practice manual
  • State land approved forms (model forms for information only)

    Additional forms (external link) are available from Landgate.

    Dampier to Bunbury Natural Gas Pipeline (DBNGP) corridor

    Title

     Type

    Size 

    Application form to undertake land use activities and works in the Dampier to Bunbury Natural Gas Pipeline (DBNGP) Corridor 

    pdf, doc

    119Kb, 85Kb

    Request for amendments to Crown Land Administration and Registration Practice Manual

    Title

     Type

    Size 

    Request for amendments to State land administration and registration practice manual

    pdf

    60Kb

    State land approved forms (model forms for information only)

    Important note: A number of specific State land forms have been created and approved under section 278 of the Land Administration Act 1997. Only Department's staff can complete the forms.  The list of approved forms provided below is for information only.  They have been completed in order to demonstrate to you the type of information that will be required by the Department when it is completing these forms. For further information please contact us.

    Title

     Form

     Type

    Size 

    Acquisition order 1000

    pdf

    26Kb

    Adjustment of boundaries – continuing interests 1001

    pdf

    10Kb

    Amalgamation of pastoral lease order 1002 

    pdf

    10Kb

    Amalgamation order for certain class “A” reserves 1098

    pdf

    33Kb

    Amalgamation order for class “A” reserves 1097

    pdf

    31Kb

    Amend notice of intention to take land (as to defects), LAA 1997 1074

    pdf

    15K

    Amend notice of intention to take land (as to defects), LAA 1997 Native Title Act 1993 1075

    pdf

    20Kb

    Amend notice of intention to take land, LAA 1997 1087

    pdf

    20Kb

    Amend notice of intention to take land, LAA 1997, Native Title Act 1993 1088

    pdf

    20Kb

    Amend taking order (as to defects), LAA 1997 as amended 1073

    pdf

    17Kb

    Amend/annul taking order, LAA 1997 1085

    pdf

    13Kb

    Amendment of order authorising taking for the purpose of conferring interests under written law 1096

    pdf

    26Kb

    Amendment of reserve 1004

    pdf

    26Kb

    Annual return of livestock and improvement (PLBU) 1109

    pdf

    148Kb

    Application for new titles 1008

    pdf

    20Kb

    Cancel notice of intention to take interests in land 1086

    pdf

    20Kb

    Cancellation of Memorial of Charge 1107

    pdf

    12Kb

    Cancellation - mall reserve 1009

    pdf

    25Kb

    Caveat of crown land 1066

    pdf

    23Kb

    Change of designation 1010

    pdf

    26Kb

    Change of designation 1010A

    pdf

    26Kb

    Change of designation 1010B

    pdf

    26Kb

    Change of designation 1010C

    pdf

    26Kb

    Change of reserve purpose 1011

    pdf

    10Kb

    Claim for compensation 1026

    pdf

    26Kb

    Consent and statutory declaration of assessor

    1027

    pdf

    31Kb

    Conveyance and amalgamation order (freehold)

    1003

    pdf

    34Kb

    Conveyance and amalgamation order - section 87(3) (freehold)

    1003A

    pdf

    34Kb

    Covenant in gross on Crown land 1092

    pdf

    36Kb

    Covenant on Crown land 1093

    pdf

    34Kb

    Creation – mall reserve 1014

    pdf

    29Kb

    Creation – reserve (except class A) 1015

    pdf

    10Kb

    Creation of class ‘A’ reserve 1015A

    pdf

    281Kb

    Designation cancellation (electricity corporation) 1018B

    pdf

    100Kb

    Designation cancellation (gas corporation) 1018C

    pdf

    10Kb

    Designation cancellation (Minister for Lands) 1018

    pdf

    10Kb

    Designation cancellation (Water Corporation) 1018A

    pdf

    10Kb

    Discharge of covenant 1103

    pdf

    27Kb

    Easement 1060B

    pdf

    44Kb

    Easement cancellation (Section 144(3)) 1016

    pdf

    22Kb

    Easement cancellation (Section 145(1)) 1016A

    pdf

    23Kb

    Easement cancellation (Section 150(5)) 1016B

    pdf

    22Kb

    Easement in gross 1060A

    pdf

    35Kb

    Easement variation 1060

    pdf

    24Kb

    Expired lease statement 1 (former lessee – nil encumbrances)   

    pdf

    11Kb

    Expired lease statement 2 (lessee in occupation– nil encumbrances)  

    pdf

    10Kb

    Expired lease statement 3 (former lessee – with encumbrances) 

     

    pdf

    13Kb

    Expired lease statement 4 (former lessee no longer in occupation)   

    pdf

    13Kb

    Extension of lease 1019

    pdf

    30Kb

    Extracts of orders for taking land 1072

    pdf

    20Kb

    Forfeiture order (Crown land interest) 1020

    pdf

    20Kb

    Forfeiture order (Freehold) 1021

    pdf

    10Kb

    Change of Reserve Purpose 1011

    pdf

    10Kb

    Increased period of currency of notice of intention to take 1068

    pdf

    10Kb

    Land district/townsite abolition 1053

    pdf

    9Kb

    Land district/townsite creation 1054

    pdf

    9Kb

    Land district/townsite redefinition of boundaries 1052

    pdf

    10Kb

    Lease of Crown and freehold land  1022A

    pdf

    36Kb

    Lease of Crown land and amalgamation order (leasehold) 1003A

    pdf

    41Kb

    Lease of Crown land and amalgamation order - section 87(3) (leasehold) 1003C

    pdf

    41Kb

    Lease of Crown land 1022

    pdf

    37Kb

    Management order – mall reserve 1102

    pdf

    25Kb

    Management order

    1023

    pdf

    7Kb

    Management plan 1106

    pdf

    23Kb

    Memorial of covenant charge 1024

    pdf

    10Kb

    Memorial of Pastoral Business Unit 1070

    pdf

    25K

    Memorial of statement under Section 17 1025

    pdf

    23Kb

    Modification of a covenant 1104

    pdf

    29Kb

    Notice of appointment of assessor (Section 224(1 & 2) 1089

    pdf

    53Kb

    Notice of appointment of assessor (Section 224(3) 1090

    pdf

    24Kb

    Notice of dispute as to title 1028

    pdf

    34Kb

    Notice of intention to cancel easement (Section 145(1)) 1013

    pdf

    38Kb

    Notice of intention to cancel easement (Section 150(2)) 1013A

    pdf

    27Kb

    Notice of intention to enter (Section 182)

    1032

    pdf

    31Kb

    Notice of intention to enter (Section 183) 1032A

    pdf

    33Kb

    Notice of intention to enter (Section 184) 1032B

    pdf

    30Kb

    Notice if Intention to enter (Section 185) 1032C

    pdf

    31Kb

    Notice of intention to forfeit 1012

    pdf

    33Kb

    Notice of intention to take amendment 1031

    pdf

    8Kb

    Notice of intention to take cancellation 1030

    pdf

    8Kb

    Notice of intention to take interests for a public work, LAA 1997 1079

    pdf

    21Kb

    Notice of intention to take interests in land for a public work, LAA 1997, Native Title Act 1993 (Cth) 1080

    pdf

    23Kb

    Notice of intention to take interests in land to confer interests under written law, LAA 1997 (Section 170) and to compulsory acquire Native Title rights and Interests Native Title Act 1993 (Cth) (Section 29) 1078

    pdf

    25Kb

    Notice of intention to take interests in land to confer interests under written law, LAA 1997 1076

    pdf

    23Kb

    Notice of intention to take interests in land to confer interests under written law, LAA 1997, Native Title Act 1993 (Cth) (Section 24MD) (6A) & (6B) 1077

    pdf

    25Kb

    Notice of intention to take 1029

    pdf

    10Kb

    Notice to remedy default 1091

    pdf

    28Kb

    Offer of compensation 1007

    pdf

    38Kb

    Order authorising taking for the purpose of conferring Interests under written law

    1069

    pdf

    25Kb

    Order for addition of land to certain class “A” reserves 1099

    pdf

    32Kb

    Order for addition of land to class “A” reserves 1100

    pdf

    28Kb

    Order increasing period of currency of notice of intention to take interests in land, LAA 1997 (Section 170) (7) & (8) 1081

    pdf

    17Kb

    Pastoral lease boundary amendment order 1034

    pdf

    22Kb

    Permit for agricultural use 1035

    pdf

    21Kb

    Permit for non pastoral use of enclosed or improved land 1036

    pdf

    23Kb

    Permit for the use of land for tourism 1063

    pdf

    23Kb

    Permit to clear land 1064

    pdf

    23Kb

    Permit to keep or sell prohibited stock 1036A

    pdf

    10Kb

    Permit to sow non indigenous pasture 1037

    pdf

    22Kb

    Profit a prendre 1038

    pdf

    36Kb

    Public access route cancellation 1040

    pdf

    25Kb

    Public access route declaration

    1039

    pdf

    23Kb

    Public access route variation 1041

    pdf

    29Kb

    Rejection of offer of compensation 1033

    pdf

    31Kb

    Removal of conditions from freehold conditional tenure (with cancellation of memorial) 1061

    pdf

    25Kb

    Removal of expired term lease 1067

    pdf

    34Kb

    Reserve cancellation 1042

    pdf

    10Kb

    Revestment order 1043

    pdf

    30Kb

    Revocation of management order (Sec 50(1)) 1105

    pdf

    28Kb

    Revocation of management order 1044

    pdf

    23Kb

    Revocation of order authorising taking for the purpose of conferring Interests under written law 1095

    pdf

    25Kb

    Road closure 1045

    pdf

    24Kb

    Road dedication 1046

    pdf

    10Kb

    Statement of procedures 1094

    pdf

    87Kb

    Statement of procedures for the taking of State corridor rights and other interests in land within the DBNGP corridor by agreement or without agreement 1108

    pdf

    100Kb

    Statutory declaration 1 (creation of CLT, Westrail – land not in rail corridor) 

    pdf

    20Kb
    Statutory declaration 2 (for the issuing of a CLT, and an interest holder does not wish to register their interest) 

    pdf

    21Kb
    Statutory declaration 3 (for validating a CLT where the original or duplicate lease is lost) 

    pdf

    24Kb
    Statutory declaration 4 (for validating a CLT with interests) 

    pdf

    31Kb

    Statutory declaration 5 (for validating a CLT with no interests) 

    pdf

    24Kb

    Statutory declaration 6 (for validating a “Head” CLT) 

    pdf

    24Kb
    Sub lease 1065

    pdf

    15Kb

    Surrender of lease 1047

    pdf

    27Kb

    Taking order 1049

    pdf

    10Kb

    Taking order amendment 1048

    pdf

    10Kb

    Taking order annulment 1006

    pdf

    24Kb

    Taking order of land for public works, (with agreement) LAA 1997, (Section 177 (3)) 1084

    pdf

    19Kb

    Taking order of land for public works, LAA 1997, (Section 178 (1) (b) (ii) & (c)) 1083

    pdf

    20Kb

    Taking order of land to confer interests under written law, LAA 1997, (Section 178 (1) (b) (ii) & 2 (d))

    1082

    pdf

    21Kb

    Temporary care, control and management authorisation 1050

    pdf

    10Kb

    Topographical feature, road and reserve names order 1005

    pdf

    10Kb

    Transfer by Minister for Lands under power of sale 1055

    pdf

    11Kb

    Transfer of land (State of Western Australia) (T1) 1056

    pdf

    27Kb

    Transfer of land (State of Western Australia) (T2) 1056A

    pdf

    38Kb

    Transfer of mortgage, charge or lease 1056B

    pdf

    30Kb

    Variation of lease 1062

    pdf

    10Kb

    Variation of management order 1057

    pdf

    24Kb

    Variation of pastoral lease 1062A

    pdf

    12Kb

    Withdrawal of default notice 1058

    pdf

    23Kb

    Withdrawal of memorial of Pastoral Business Unit 1071

    pdf

    10Kb

    Withdrawal of temporary care, control and management authorisation

    1059

    pdf

    23Kb

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  • Department of Regional Development and Lands