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Land Title Act
Form C

(Section 219.9)
Province of
British Columbia

GENERAL DOCUMENT (This area for Land Title Office use) Page 1 of pages

1. Application: (Name, address, phone number and signature of applicant, applicant's solicitor or agent)

Lidstone, Young, Anderson

Barristers and Solicitors

1414 - 868 Nelson Street

Vancouver, B.C. V6Z 2H? (689-7400) Solicitor

2. Parcel Identifier and Legal Description of Land:*
CPID) (Legal Description)

3. Nature of Interest:* Document Reference
Description (page and paragraph) Person Entitled to Interest

Statutory Right of Way Agreement

4. Transferor(s):%

5. Transferee(s) ° Cineluding occupation(s}, postal address(es) and postal code(s))*

The Corporation of the City of Port Coquitlam
2580 Shaughnessy Street
Port Coquitlam, B.c. v3e 2A8

6. Execution(s) 2** By signing this document you are affecting the land in the manner described in item 3.
Execution Date

Officer Signature (s) ¥} MID Transferor(s) Signature(s)

OFFICER CERTIFICATION:

Your signature constitutes a representation that ry public or other person authorized by the Evidence
Act R.S.B.C. 1979, «©. 116, t i British Columbia and certifies the matters set out in Part 5 of the
Land Title Act as th this instrument.

¥ ter. “SEE SCHEDULE" and attach schedute in Form €.

e ontinue executions on additional ets) in Form bp.

ITEM | PAGE

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