POPES |, ons no. unas LAND TITLE ACT

Form 2
Sections 43(a) and 44(z)

AFFIDAVIT OF WITNESS

.of © mo : :
in British Columbia, make oath and say:

..1 was present and saw this instrument duly signed and executed by LEO WILLIAM DERBACH
the party(ies) to it, for the purposes named in it.
The instrument was executed at .

I know the party(ies) who is(are) 19 years old or more.

Tam the subscribing witness to the instrument and am 16 years old or more.”

Sworn before me at

in British Columbia, this”

‘day of —_

" ¢Write name and qualifications under section 48; eB A Commissioner for Taking Affidavits for British Columbia.
NOTE: This affidavit must be sworn by a witness who is nox a party co the instrument. -

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