PLEASE PRINT
INDIVIDUAL S)
SURNAME(S)

it

ANO GIVEN NAME
NAME(S) (#* INDICATE
JOINT TENANCY JF
OESIRED}

Lenporaz tony of

OAR
COMPANY
NAME

1 L 1 1 I tL

CALEY Jot Pert, Goqudplan |

1 i i i i L L h L
POST OFFICE BOX NUMBER
§ tC, J L 1 iT i i i

POSTAC COGE

ADORESS b»
{* FURNISH
SOTH STREET
AND MAILING)

9,41

"AREA CODE

$3 41,1;6,0,4

,5,t = &
/ PROVINCE

C,

Ve GzA 8,

OMPANY INC NO

| l 1 i] ']

est

Yes (J

| CANADIAN

YES ()| AESIDENTIN

NO [J

BRITISH COLUMBIA FOR 2 YEARS

NO ()] CITIZEN

AGE
19 YEARS ano over
LOCATION :

orgaown >| Oe
LAND __Port Coquitlam

DATE STAMP

CROWN LAND
{S .

i SURVEYED

305, Group One, New

GIVE LEGAL
DESCRIPTION [

attached plan,

Westminster District shown outlined red-on the

OR

iC] UNSUAVEYED
GIVE METES

ANO BOUNDS
DESCRIPTION

x
Ez
[

OTEs

1. ATTACH PRELIMINARY OEVELOPMENT PLAN 2. ATTACH A SKETCH MAP OF AREA

PURPOSE

FOR >|

Free Crown Grant for Municipal Park

purposes.

CROWN LAND

iS. LANO
# ACCESSIBLE

BY PUBLIC ROAD

O ves © no ENO

STATE

to be consolidated with adjoining park designated land. |

DATE LAND > PLAN

ACCESS

STAKED

P-OTHER. -
a. CROWN LAND b>
I HOLDINGS

BY APPLICANT OR SPOUSE
0 ves O No

ANY OTHER CROWN LAND HELD.

STATE TYPE

IFYES: -
ANDO TENURE

| HEREBY CERTIFY THAT ALL INFORMATION GIVEN IN THIS APPLICATION FOR CROWN LAND IS TRUE ANO
OCCUPATION (IF INDIVIDUAL(S)) OR CORPORATE POSITION IF COMPANY) ~

APPLICANT

DECLARATION”
DATE

APPLICANT
SIGNATURE(S)

FOR OFFICE USE ONLY

O new

APPLICATION IS

(CC) RENEWAL

I A

APPLICATION IS LANDIS IN
(] PLANNED
AREA

LAND MINISTRY
O O) act

(Q UNPLANNEO © PROVINCIAL
AREA FOREST

APPLICATION FOR
( FORE.
SHORE

OTHER
O LANO |

ACT
TYPE OF TENURE FOR APPLICATION
LEASE LICENCE OF

C) WITH C] OCCUPATION
RENTAL WITH RENTAL

CO] Lerten oF
CONSENT
CO] PREPAID LEASE

CO EASEMENT
RIGHT OF way
( CROWN GRANT

PRELIMINARY ESTIMATE !
OF LANO VALUE i

i

 [s I i ry i.
REPLACES SUP

O ves (no

PREPAIO LICENCE

a) OF OCCUPATION

i
!
i
}

DISTRICT OFFICE
FILE COPY

is LAND INSPECTION OC) Yes
EQUIREO 1 8 CJ No

ESTIMATE OF TIME TO
COMPLETE LAND INSPECTION

C) wittin ge pays '
( MORE THAN99 Dar |

L ta Azam