EA A Tern AES acho Bin ad a oe oe

~2-

and | will AT MY OWN EXPENSE REMOVE a] | buildings and structures, including
foundations, proporting to be authorized by it within ten (10) days of being

requested by the City to so do AND IF for any reason |! neglect or refuse to so

do, | hereby authorize the City in its sole discretion to enter the Lands and

effect the removal as aforesaid and | will forthwith thereafter fully reimburse

the Civy for all costs it incurs in so doing.

IN WITNESS WHEREOF having first read and fully understood this statement [| have
hereunto set my hand and seal this day of , 198.

SIGNED, SEALED AND DELIVERED in
Port Coquititam, British Columbia,
in the presence of

Signature of Witness

.Name (Please Print) (SEAL)
Street Address
City, Province, Postal! Code

OWNER

aati a Oe Oe

Occupation

Bylaw 2034

AS