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AND I made the solemn declaration conaclentiously believing it to be true, and
knowing that it is of the same force and effect as if made under oath and by
virtue of the Canada Evidence Act,

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DECLARED BEFORE ME at

in the Province of British
Columbia this day o£

, 19

Nee Ne Net Ne? Ce’ Se NY BLY NY LY UY SU CL NU

A Notary Public in the

Province of British Columbia

A Commissioner for taking
Affidavits for British Columbia

THIS DECLARATION MUST BE SUBMITTED TO THE CITY OF PORT COQUITLAM WITHIN ONE
MONTH OF THE EXPIRY OF A SOIL DEPOSIT PERMIT.