STATUTORY DECLARATION

IN THE MATTER OF

I,	of,

in the Province of Alberta, DO SOLEMNLY DECLARE THAT:

1.	I am an Employee of Alberta Treasury Branches (the “Mortgagee”) in connection with a Mortgage (the “New Mortgage”) made between the Mortgagee and (the “Borrowers”).

2.	The Mortgagee presently holds a mortgage (the “Old Mortgage”) registered as instrument number against lands owned or previously owned by the Borrowers.

The Borrowers have requested that the Mortgagee accept the New Mortgage against the above noted property as a substitute for the Old Mortgage. Ultimately the Mortgagee will discharge the Old Mortgage.

No new monies being advanced

Based on the foregoing and the fact that no new monies are being advanced, I make this declaration so as to have the Registrar of Titles charge minimum tariff on the registration of the New Mortgage referred to in item 1. hereof.

New monies being advanced

Based on the foregoing and the fact that only $ in new monies are being advanced, I make this declaration so as to have the Registrar of Titles charge registration fees on the New Mortgage based on the increase of $ .

AND I make this solemn declaration conscientiously believing it to be true and knowing it is of the same force and effect as if made under oath.

DECLARED before me at

in the Province of Alberta,

this day of , .

A Commissioner for Oaths in and for the

Province of Alberta

(Print or Stamp Name Next to Signature)

My Commission Expires:

Form 3553	Replacement Mortgage

(11/03)

3553 Form - Statutory Declaration-Replacement Mtge

e12504

2005-06-22

Information

Alberta Treasury Branches