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and | will AT MY OWN EXPENSE REMOVE all buildings end structures, including
foundations, proporting to be authorized by it within ten (103 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 t will forthwith thereafter fully reimburse

the City 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 Coquitlam, British Columbia,
in the presence of

Signature of Witness

Name (Please Print) (SEAL)

Street Address

City, Province, Postal Code

Occupation

Bylaw 2034

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