Land Titles

FORM A Statutory Declaration Re: Proof of Identity

I,

of

DO SOLEMNLY DECLARE THAT:

1. I am the Registered Owner of the land described in Certificate of Title Numbers:

legally described as:

2. I am ONE AND THE SAME PERSON as:

3. I request the Registrar to correct the name in the above title to read: 4. Attached and marked as Schedule ‘A’ in support of this Statutory Declaration is:

5. The explanation for the discrepancy in names is:

AND I MAKE THIS SOLEMN DECLARATION CONSCIENTIOUSLY BELIEVING IT TO BE TRUE AND KNOWING THAT IT IS OF THE SAME FORCE AND EFFECT AS IF MADE UNDER OATH, AND BY VIRTUE OF THE CANADA EVIDENCE ACT.

DECLARED before me at

In the

this day of ,

(Signature of Declarant) (Print or Stamp Name of Commissioner) (Expiry Date of Commission or Office)