Form CSB17007 "Surrender of Disposition Lease, Permit or Wild Rice Licence" - Saskatchewan, Canada

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Download Form CSB17007 "Surrender of Disposition Lease, Permit or Wild Rice Licence" - Saskatchewan, Canada

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Ministry of Environment
Surrender of Disposition
Lease, Permit or Wild Rice Licence
October 2015| CSB | CSB17007
“Surrenderer”
“Surrenderer”
(Second Lease, Permit or Licence Holder)
(Lease, Permit or Licence Holder)
I,
I,
of
of
Telephone Number
Telephone Number
In consideration of my release from the terms and conditions of the Disposition with the Property Number
, respecting the land described as follows (the “Land”):
Parcel/Lot
Block
Plan
Subdivision
LSD
Quarter
Township
Section
West of the
Meridian
Unsurveyed area, location described as
Do hereby, for myself, successors and assigns, surrender to Her Majesty the Queen in right of Saskatchewan the
Land and Improvements demised by the Disposition and the unexpired term of years created by it, together with
other associated permits of licences as follows:
Effective Date:
And I further release, quit claim and reconvey unto Her Majesty the Queen I right of Saskatchewan all my estate,
right, title and interest, both at law and in equity in the Land, together with any improvements not removed from
the land within six months of the date of this Surrender.
Signed this
day of
,
20
Surrenderer
Witness
Surrenderer
Witness
Page 1 of 4
PRINT
CLEAR
SAVE
SUBMIT
Ministry of Environment
Surrender of Disposition
Lease, Permit or Wild Rice Licence
October 2015| CSB | CSB17007
“Surrenderer”
“Surrenderer”
(Second Lease, Permit or Licence Holder)
(Lease, Permit or Licence Holder)
I,
I,
of
of
Telephone Number
Telephone Number
In consideration of my release from the terms and conditions of the Disposition with the Property Number
, respecting the land described as follows (the “Land”):
Parcel/Lot
Block
Plan
Subdivision
LSD
Quarter
Township
Section
West of the
Meridian
Unsurveyed area, location described as
Do hereby, for myself, successors and assigns, surrender to Her Majesty the Queen in right of Saskatchewan the
Land and Improvements demised by the Disposition and the unexpired term of years created by it, together with
other associated permits of licences as follows:
Effective Date:
And I further release, quit claim and reconvey unto Her Majesty the Queen I right of Saskatchewan all my estate,
right, title and interest, both at law and in equity in the Land, together with any improvements not removed from
the land within six months of the date of this Surrender.
Signed this
day of
,
20
Surrenderer
Witness
Surrenderer
Witness
Page 1 of 4
Affidavit of Execution
- to be completed by each witness
I,
of the
of
in the Province of
make oath and say:
1. That I was personally present and did see
named in the above Assignment who is personally known to me to be the person(s) named therein, duly sign
and execute the same for the purposes named therein;
2. That the same was executed at the
of
in the Province of
and that I am a subscribing witness thereto;
3. That I know the said
and he/she/each is/are in my belief eighteen years of age or more.
Witness Signature
Sworn before me at
In the Province of
This
day of
, 20
My appointment expires
A Justice of the Peace, Notary Public or Commissioner
for Oaths in and for the Province of Saskatchewan.
Affidavit of Execution
- to be completed by each witness
I,
of the
of
in the Province of
make oath and say:
1. That I was personally present and did see
named in the above Assignment who is personally known to me to be the person(s) named therein, duly sign
and execute the same for the purposes named therein;
2. That the same was executed at the
of
in the Province of
and that I am a subscribing witness thereto;
3. That I know the said
and he/she/each is/are in my belief eighteen years of age or more.
Witness Signature
Sworn before me at
In the Province of
This
, 20
day of
My appointment expires
A Justice of the Peace, Notary Public or Commissioner
for Oaths in and for the Province of Saskatchewan.
Page 2 of 4
Form A
of The Homesteads Act, 1989 (Section 6): Consent of Non-Owning Spouse
1
To be completed when the Land was used by both spouses as the family home at any time during their marriage ,
also see Form B.
I,
, consent to the above/attached Assignment.
, non-owning spouse of
I declare that I have signed this consent for the purpose of relinquishing all my homestead rights in the Land
described in the above/attached Assignment in favour of Her Majesty the Queen in the Rights of Saskatchewan to
the extent necessary to give effect to this Assignment.
Signature of Non-Owning Spouse
Form B
of The Homesteads Act, 1989 (Subsection 7 (3)): Certificate of Acknowledgment
To be completed by a Judge, Justice of the Peace, Solicitor or Notary Public at the time Form A: Consent of
1
Non-Owning Spouse is completed .
I,
(capacity), certify that I have
,
examined
, the owning
, non-owning spouse of
spouse in the above/attached Disposition, separate and apart from the owning spouse. The non-owning spouse
acknowledged to me that he or she:
a)
Signed the consent to the Assignment of his or her own free will and consent and without any compulsion on
the part of the owning spouse; and
b) Understands his or her rights in the homestead.
I further certify that I have not, nor has my employer, partner or clerk, prepared the above/attached Assignment
and that I am not, nor is my employer, partner or clerk otherwise interested in the transaction involved.
Signature
1
See The Homesteads Act, 1989 for detailed information on when and how each form is to be completed.
NOTE: Forms C, E, and F are not required for a Quit Claim Deed and have not been included.
Page 3 of 4
Form D
of The Homesteads Act, 1989 (Subsection 8 (1)): Affidavit
To be completed when homestead rights are not applicable, e.g. not a family home, no spouse, owning spouse
1
signing as an Assignor, etc.
I,
, of
, make oath and say that:
(State capacity in which person acts on behalf of the owner, e.g.
1. I am the Assignor or
agent acting under the Power of Attorney.)
Select
ALL incorrect responses:
2. My spouse and I (or the Assignor and his or her spouse) have not occupied the Land described in this
Assignment as our (or their) homestead at any time during our (or their) marriage. - or -
2. I have (or The Assignor has) no spouse. - or -
2. My spouse (or The spouse of the Assignor) has a registered interest in the Land that is the subject matter of
this Assignment and a co-signer of this Assignment. - or -
2. My spouse and I (or he Assignor and his or her spouse) have entered into an inter-spousal agreement pursuant
to The Matrimonial Property Act in which my spouse (or his or her spouse) has specifically released all his or
her homestead rights in the Land that is the subject matter of this Assignment. - or -
2. An order has been made by Her Majesty’s Court of Queen’s Bench for Saskatchewan/Unified Family Court
pursuant to The Matrimonial Property Act declaring that my spouse (or the spouse of the Assignor) has no
homestead rights in the Land that is the subject matter of this Assignment and (the order has not been
appealed and the time for appealing has expired) or (all appeals from the order have been disposed of or
discontinued). - or -
2. My spouse (or The spouse of the Assignor) is the assignee named in this Assignment.
Sworn before me at
In the Province of
, 20
This
day of
My appointment expires
A Justice of the Peace, Notary Public or Commissioner
for Oaths in and for the Province of Saskatchewan.
Assignor
Assignor
What if I have questions?
For assistance completing this application or for more information, please contact our Client Service Office:
Email:
centre.inquiry@gov.sk.ca
Telephone (toll free in North America):
1-800-567-4224
Telephone (Regina):
306-787-2584
1
See The Homesteads Act, 1989 for detailed information on when and how each form is to be completed.
NOTE: Forms C, E, and F are not required for a Quit Claim Deed and have not been included.
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