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Land Title Act

FORM D
EXECUTIONS CONTINUED

Officer Signature(s) Execution Date Transferor(s) Signature(s)
SIGN IN BLACK INK ONLY

_° OFFICER CERTIFICATION: | Pe een
Your signature constitutes a representation that you are a solicitor, notary public or other person naire 3
by the Evidence Act, R.S.B.C., c. 116, to take affidavits of use in British Columbia and cert ies the”
‘matters set out in Part 5 of the Land Title Act as they pertain to the execution of this instrument, ne

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