Disposition Renewal Application Form

Disposition#
DateofApplication
ClientID
ClientEmail

Throughthisapplication,astheDispositionholderorastheirdesignatedrepresentative,IsolemnlydeclarethatthefollowingitemsareingoodstandingforthisdispositionRenewaltoproceed.

The formal disposition was entered on date , 20 as verified by the Notification of Entry Number (if applicable).

The formal disposition was constructed within the survey boundaries as represented by the disposition plan on file and no further site changes have occurred to the disposition (as confirmed by the completed declaration – page 2).

Theformaldispositioncontinuestobeusedandoperatedforthepurposeidentifiedonthedispositionasapprovedandoriginallyintended.

Theholderisincompliancewiththetermsandconditionsoftheformaldispositionauthorityandthereiscurrentlynocompliancefilesunderreviewinrespectstothisformaldisposition.

Theformaldispositiondoesnotconflictwithadjacentusers.

I , as Disposition holder or representative thereof, are aware that should the formal disposition being requested for renewal as identified above not meet any of the above criteria, the disposition holder must select one of the following options:

ApplyforAmendmentoftheformaldispositioninquestion
RequestCancellationoftheformaldispositioninquestionandsubmittotheDepartmenttherequireddocumentationforReclamationCertificationorLetterofClearanceorNon-EntryConfirmation.

As representative of the company, I solemnly declare this Renewal Application to be true and accurate andshoulditbefoundthroughtherevieworissuanceofaRenewaltermthatthisapplicationhasbeensubmittederroneouslyorwithfalsifiedinformation,theDispositionholdermaybesubjecttoenforcementactionleadinguptoandincludingpossibledispositioncancellation.

Signature(Position/Relationshipto Disposition Holder)

Survey/Location Plan StatutoryDeclaration

I,, AlbertaLand Surveyor,solemnlydeclarethat Disposition number was constructed within theboundaries as represented onthe Planof Surveyon filewith Environment and Parks,plannumber ,version date and Imakethissolemn declaration conscientiouslybelieving it to be trueand knowing thatit isofthesameforceand effect as ifmadeunderoath.

Declared beforemeat

Thisdayof,20

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AlbertaLand Surveyor

______

ACommissionerforOaths in and forAlberta

Commission expireson ,20.