Land Title Act (Section 219.9)
Province of British Columbia

FORM C
GENERAL DOCUMENT

Page | of 7 pages

1. APPLICATION
GREATER VANCOUVER SEWERAGE
AND DRAINAGE DISTRICT
4330 Kingsway,
Burnaby, B.C. VW5H 4G8
Telephone: 432-6480

Attention:

(signature)

PARCEL IDENTIFIER(S) AND LEGAL DESCRIPTION(S) OF LAND: :*

(PID) (LEGAL DESCRIPTION)

016-465-563 Lot | DL, 290 Group 1 NWD Plan 86838
012-425-443 Lot | Block 5 DE 290 Group | NWD Plan 1957

NATURE OF INTEREST:*

DESCRIPTION DOCUMENT REFERENCE PERSON ENTITLED TO INTEREST

Statutory Entire Document
Right-of-Way (Pages 4 to 7)

Transferee

DISTRICT, a corporation created by Act of the D DEAL of the
Province of British Columbia, 4330 Kingsway, Burnaby, B.C. V5H 4G8

6. EXECUTION(S):** l'y signing this document you are affecting the land in the manner

dascribed in item 3.
Officer Signature(s) | Execution Date

Transferee(s) Signature(s)
GREATER VANCOUVER
SEWERAGE AND DRAINAGE
DISTRICT by its authorized
signatories

BEN E. MARR

OFFICER CERTIFICATION:

NANCY GRANT
SIGN IN BLACK INK ONLY

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 Act as they pertain to the. execution of this

instrument.

$ — If space insufficient, enter "SEE SCHEDULE" and attach schedule in Form E.
oe If space insufficient, continue executions on additional page(s) in Form dD.