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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

THE CITY OF PORT
COQUITLAM, by its authorized
signatories

_ OFFICER CERTIFICATION: _ | ve |

Your signature constitutes a representation that you are a solicitor, ‘notary public: or other. person
authorized by the Evidence Act, R.S.B.C., to take affidavits of use in British Columbia and
certifies the matters set out in Part 5 of-thpelpadTitle Act as they pertain to the execution of this

instrument.