Foreign Ownership of Land Regulations (SOR/79-416)

I (We)

of

(full address including street, municipality and country.)

SOLEMNLY DECLARE THAT:

• • 1 I (We) am (are) the transferee(s), transmittee(s), caveator(s) or lessee(s) named in the above instrument and will hold the interest in the land beneficially and not as trustee(s) and not on behalf of any person and I (we) am (are) a citizen(s) of the country of and am (are) not a permanent resident(s) within the meaning of the Immigration Act, 1976 (Canada).

  or

  I am a member of the Law Society of Alberta and am the solicitor for the transferee(s), transmittee(s), caveator(s) or lessee(s) named in the above described instrument who will hold the interest in the land beneficially and not as trustee(s) and not on behalf of any person and who is (are) a citizen(s) of the country of and is (are) not a permanent resident(s) within the meaning of the Immigration Act, 1976 (Canada).

  or

  of

  (name of corporation(s))

  

  (mailing address)

  is (are) the transferee(s), transmittee(s), caveator(s) or lessee(s) named in the above described instrument; will hold the interest in the land beneficially and not as trustee(s) and not on behalf of any person; and is (are) a “foreign controlled corporation(s)” as defined in the Foreign Ownership of Land Regulations. The majority of the shares or memberships are held by persons from the country of . I am a person authorized under section 22(2) of the Foreign Ownership of Land Regulations to sign on behalf of the transferee(s), transmittee(s), caveator(s) or lessee(s) named in the above described instrument.

• • 2 The interest is being acquired under a statutory exemption, section of the Foreign Ownership of Land Regulations. (If acquiring an interest under: 1) section 4(2), a copy of the letters probate or letters of administration must form an exhibit to this declaration and 2) section 9, a copy of the agreement must form an exhibit to this declaration.)

  or

  The interest is being acquired under O.C. No. passed

  (day/month/year)

• • 3 The true consideration paid or payable in respect of the transactionFootnote ^* is as follows:

  (give full details of purchase or rental as applicable, including total price paid)

• • 4 The present value of the landFootnote ^*, in my opinion, is $  

  (“land includes buildings and all other improvements affixed to the land”)

• Return to footnote ^*Answer required only for transmissions, caveats and leases.

AND I (WE) 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.