Consent of Occupant Form C




Дата канвертавання22.04.2016
Памер12.49 Kb.

I/We,      

of      

in the Province of Alberta, IN CONSIDERATION of the sum of $     

      dollars

paid to me (us) by the pipeline operator, receipt of which is hereby acknowledged, and in consideration of the covenants and agreements hereinafter mentioned and on the part of the pipeline operator to be kept, observed and performed:


I/We,      

DO HEREBY CONSENT to the pipeline operator, its successors and assigns, its contractors, subcontractors, servants and agents the right, license, liberty, privilege and easement to enter upon, over, under and through all those portions of:      



     

(the lands described in the lease, licence, permit) numbered       dated the



      day of       ,      , and made between Her Majesty the Queen in right of the Province as represented by the Regulatory body (Minister of Environment and Sustainable Resource Development or the Alberta Energy Regulator) as Grantor and me (us) as Grantee at any time and from time to time with vehicles and equipment for the purposes permitted by the Public Lands Administration Regulation and any regulations passed in substitution therefor.
THE PIPELINE OPERATOR HEREBY COVENANTS AND AGREES to compensate me (us) for damage done to my (our) buildings, growing crops, fences and livestock on the said land by reason of the exercise of the rights hereby granted.
If my (our) right to occupy the said land terminates for any reason, this consent and covenants and agreements herein contained shall then and in that event cease and determine.
This consent is given under my (our) hand expressly for the purpose of satisfying the requirements of Section 12 of the Surface Rights Act or any other relevant or applicable legislation.
This consent shall be binding upon and shall enure to the benefit of my (our) heirs, executors, administrators and assigns.
IN WITNESS WHEREOF I/WE, have executed this consent at      

     

in the Province of Alberta, this       day of       , 20     .


SIGNED AND DELIVERED

by      

In the presence of:
     

WITNESS


     

OCCUPANT


     

OCCUPANT






This consent is hereby acknowledged and accepted by the pipeline operator.
Per:      




Personal information in this form is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act and will be used to administer the Public Lands Act and its associated regulations. This form is a public record and is available to anyone. All information contained on this form (including personal information) may be disclosed by Alberta Environment and Sustainable Resource Development to anyone requesting a copy in accordance with sections 166-167 of the Public Lands Administration Regulation. For further information about the collection and use of this information, please contact 780-427-3570.

Decr 1, 2013

Consent of Occupant – Form C

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