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Land Title Act

FORM D
EXECUTIONS CONTINUED

Execution Date

Officer Signature Transferor Signatures

Solicitor/Notary Public

OFFICER CERTIFICATION:

Your signature constitutes a representation that you are a solicitor, notary
public or other person authorized by the Evidence Act, R.S.B.C. 1979, c. 116,
to take affidavits for use in British Columbia and certifies the matters set out
in Part 5 of the Land Title Act as they pertain to the execution of this

instrument.

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