Forms Guide. Builders Lien Act. A guide to filing and. cancelling a claim. of builders lien. in British Columbia

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1 Forms Guide Builders Lien Act A guide to filing and cancelling a claim of builders lien in British Columbia Prepared by the Construction Secretariat BC Ministry of Employment and Investment Fall 1999

2 The Ministry of Employment and Investment acknowledges the assistance of the British Columbia Law Institute in developing this document. The British Columbia Law Institute is a non-profit body whose mission is to clarify and modernize the law. Canadian Cataloguing in Publication Data Main entry under title: Builders Lien Act ISBN British Columbia. Builders Lien Act. 2. Mechanics' liens - British Columbia. 3. Building laws - British Columbia. I. British Columbia. Construction Secretariat. II. British Columbia. Ministry of Employment and Investment. KEB271.5.L54I '4 C KF1058.I

3 Contents Introduction...4 Filing a lien Example 1: Filing a claim of lien against a single title by the lien claimant...6 Explanatory Notes...7 Example 2: Filing a claim of lien against a single title by an agent of the lien claimant...8 Explanatory Notes...9 Example 3: Filing a claim of lien against multiple titles Explanatory notes Cancelling a lien Example 4: Cancelling a claim of lien following payment or settlement (Form C) Explanatory notes Example 5: Cancelling a claim of lien through the expiration of time (Form 17) Explanatory notes Sample Forms Form 5 (Claim of Lien) Builders Lien Act Form C (Section 219.9) Land Title Act Form 17 (Sections 154, 155(1), 241) Land Title Act Copyright Ministry of Employment and Investment,

4 Introduction INTRODUCTION What this guide does This guide provides assistance in the simplest cases for filing and cancelling a claim of builders lien. It covers the following five (5) examples: 1. Filing a claim of lien against a single title by the lien claimant. 2. Filing a claim of lien against a single title by an agent of the lien claimant. 3. Filing a claim of lien against multiple titles of land. 4. Cancelling a claim of lien where the lien claimant agrees to the cancellation (ie, settlement). 5. Cancelling a claim of lien where one year has elapsed from the time of filing (ie, no enforcement action). The names and addresses used in this guide are for illustrative purposes only and any similarity with real persons or places is unintended. What this guide does not do This guide is not intended or offered as legal advice or as a formal ruling on the operation of the Builders Lien Act. The Ministry of Employment and Investment accepts no responsibility for the interpretation or application of the information contained herein. It is the responsibility of the reader to ensure the activity undertaken, and the accuracy of the information provided when filing, conform with the requirements of the Builders Lien Act. Where a party has any doubts as to rights, obligations and/or procedures in relation to a builders lien, consult the Builders Lien Act or seek legal advice. Forms for filing and cancelling a claim of lien are available at any Land Title Office or Government Access Centre throughout the province. You can also download forms and related documentation from the Construction Secretariat (Ministry of Employment & Investment) website. 4

5 Basic steps to filing a claim of lien To file a claim of lien, complete Form 5 under the Builders Lien Act and register the claim at the appropriate Land Title Office, in person or by mail. Include a cheque payable to the BC Minister of Finance with your documentation. Kamloops / Nelson Land Title Office Columbia Street Kamloops, British Columbia V2C 6K4 Vancouver / New Westminster Land Title Office 88-6 th Street New Westminster, British Columbia V3L 5B3 Prince George / Prince Rupert Land Title Office #153, th Avenue Prince George, British Columbia V3L 5B3 Victoria Land Title Office 850 Burdett Avenue Victoria, British Columbia V8W 1B4 The cost of filing a claim of lien against a single title is $5.00 payable to the BC Minister of Finance. The cost of filing a claim of lien against multiple titles is $5.00 times the number of titles identified under the claim. (Note that the cost of filing a claim is subject to change.) A claim of lien may be completed by either the lien claimant or an agent of the lien claimant. The lien claimant is the person or company to whom the money is owed. Accuracy in completing Form 5 is critical. Claims which are not completed accurately will be nullified. Once a lien is filed, it remains on the title for a period of one (1) year. If a lien is to be filed in the Gold Commissioner's Office, insert the name of the mineral title, its tenure number and the name of the mining division. After a claim of lien is filed If payment or settlement is not forthcoming after a claim of lien is filed in the Land Title Office, lien claimants can initiate enforcement action in the BC Supreme Court. To enforce a claim of lien, claimants are required to register a Certificate of Pending Litigation (Form 31, Land Title Act) in the BC Supreme Court. Initiating such an action is a highly technical procedure. Legal advice is recommended for this procedure. If an action to enforce a lien is not initiated within one (1) year, a title owner may apply to the Land Title Office to have the lien cancelled. This involves completing a Form 17 under the Land Title Act. In cases where payment is received or a settlement reached, a lien is cancelled by completing a Form C under the Land Title Act. There is no fee for cancelling a claim of lien. 5

6 Who completes Form 5 ( lien claimant ) Example 1: Filing a claim of lien against a single title by the lien claimant FORM 5 Builders Lien Act (Sections 15, 16, 18) CLAIM OF LIEN I, Walter Waters [ claimant ] of [ address ] 1234 Water Street, New Westminster, British Columbia [ if claim is made by an agent, insert here agent of the lien claimant ] state that: 1. Walter Waters [ claimant ] of [ address ] 1234 Water Street, New Westminster, British Columbia claims a lien against the following land: Lien claimant / address Legal description How much is owing PID Lot 3, Block 4, District Lot 5 New Westminster Land Registration District Plan A general description of the work done or material supplied, or to be done or supplied, or both, is as follows: Provision and installation of drywall materials and related services 3. The person who engaged the lien claimant, or to whom the lien claimant supplied material, and who is or will become indebted to the lien claimant is: Upscale Construction Ltd. 4. The sum of $25,000 is or will become due or owing to Walter Waters on January 1, 2000 [ Month, day, year ]. Basis of claim Who owes the money Address for Service 5. My address for service is: 1234 Water Street New Westminster, British Columbia A1B 2C3 Signed: Walter Waters [ Month, day, year ] February 1, 2000 Date form completed and signed NOTE: Section 45 of the Builders Lien Act provides as follows: 45 (1) A person who knowingly files or causes an agent to file a claim or lien containing a false statement commits an offence. (2) A person who commits an offence under subsection (1) is liable to a fine not exceeding the greater of $2,000 or the amount by which the stated claim exceeds the actual claim 6

7 Explanatory notes Who completes Form 5 Lien claimant / address Legal description Basis of claim Who owes the money How much is owing Address for service Opening Paragraph Form 5 may be completed by either the lien claimant or an agent of the lien claimant. The lien claimant is the person to whom the money is owed. Where the lien claimant is a company, the form must be completed by an agent of the lien claimant (Example 2). An agent can be a company officer or employee. An agent can also be a notary public or lawyer acting on behalf of the lien claimant. Indicate whether you are the lien claimant or an agent of the lien claimant by striking out the appropriate wording on Form 5. Insert address of the lien claimant or agent of the lien claimant. Paragraph 1 Paragraph 1 requires the name and address of the lien claimant. If the lien claimant is a company, ensure the company name is filled out accurately. Include the incorporation number where applicable. An address should be an identifiable location, such as a street address. A post office box is acceptable. Include a postal code. Paragraph 1 Paragraph 1 requires an accurate legal description of the property. The legal description identifies the location of the improvement that resulted in the claim of lien. A Parcel Identification Number (PID) and a plan number are the basic elements of a legal description. A street address is not acceptable. To obtain a legal description, contact the municipality or the BC Assessment Authority where the land is situated. Either office can provide information on the procedure to obtain the description. Legal descriptions obtained from a municipality or BC Assessment Authority may not be accurate or up-to-date. To ensure accuracy, verify the description against Land Title Office records before filing. Cost of a title search by Land Title Office staff is $9.00 (June, 1999). Paragraph 2 Paragraph 2 describes the work done and/or material supplied. Provide a brief but accurate description. Ensure the service described does in fact result in a builders lien. For example, you cannot file a claim of lien for unpaid real estate fees. Paragraph 3 Paragraph 3 requires that the person in default (the one who owes the money) be identified. This is generally the person or company who hired or contracted with the lien claimant. If that person is a company, accurately describe the company. Paragraph 4 Paragraph 4 identifies the amount owing and the date on which it became due to the lien claimant. Only include the amount that is owing. Do not include any payment amounts already received for materials or service. A lien may also be claimed for an amount which is not yet due and owing. This occurs when materials or services have been provided with payment due at a later date. In this example, paragraph 4 should identify the date when the amount will become due and owing. Paragraph 5 Paragraph 5 requires an address for service. This is the address to which subsequent documents will be directed. 7

8 Example 2: Filing a claim of lien against a single title by an agent of the lien claimant Who completes Form 5 ( agent of the lien claimant ) Legal description How much is owing FORM 5 Builders Lien Act - (Sections 15, 16, 18) CLAIM OF LIEN I, Walter Waters [ claimant ] of [ address ] 1234 Water Street, New Westminster, British Columbia [ if claim is made by an agent, insert here agent of the lien claimant ] state that: 1. Walt s Drywall Services Ltd., Inc. No [ claimant ] of [ address] 1234 Water Street, New Westminster, British Columbia claims a lien against the following land: PID Lot 3, Block 4, District Lot 5 New Westminster Land Registration District Plan A general description of the work done or material supplied, or to be done or supplied, or both, is as follows: Provision and installation of drywall materials and related services 3. The person who engaged the lien claimant, or to whom the lien claimant supplied material, and who is or will become indebted to the lien claimant is: Upscale Construction Ltd. 4. The sum of $25,000 is or will become due or owing to Walt s Drywall Services Ltd. on January 1, 2000 [ Month, day, year ]. Lien claimant / address Basis of claim Who owes the money Address for Service 5. My address for service is: 1234 Water Street New Westminster, British Columbia A1B 2C3 Signed: Walter Waters [ Month, day, year ] February 1, 2000 NOTE: Section 45 of the Builders Lien Act provides as follows: Date form completed and signed 45 (1) A person who knowingly files or causes an agent to file a claim or lien containing a false statement commits an offence. (2) A person who commits an offence under subsection (1) is liable to a fine not exceeding the greater of $2,000 or the amount by which the stated claim exceeds the actual claim. 8

9 Explanatory notes Who completes Form 5 Lien claimant / address Legal description Basis of claim Who owes the money How much is owing Address for service Opening Paragraph Form 5 may be completed by either the lien claimant or an agent of the lien claimant. The lien claimant is the person to whom the money is owed. Where the lien claimant is a company, the form must be completed by an agent of the lien claimant (Example 2). An agent can be a company officer or employee. An agent can also be a notary public or lawyer acting on behalf of the lien claimant. Indicate whether you are the lien claimant or an agent of the lien claimant by striking out the appropriate wording on Form 5. Insert address of the lien claimant or agent of the lien claimant. Paragraph 1 Paragraph 1 requires the name and address of the lien claimant. If the lien claimant is a company, ensure the company name is filled out accurately. Include the incorporation number where applicable. An address should be an identifiable location, such as a street address. A post office box is acceptable. Include a postal code. Paragraph 1 Paragraph 1 requires an accurate legal description of the property. The legal description identifies the location of the improvement that resulted in the claim of lien. A Parcel Identification Number (PID) and a plan number are the basic elements of a legal description. A street address is not acceptable. To obtain a legal description, contact the municipality or the BC Assessment Authority where the land is situated. Either office can provide information on the procedure to obtain the description. Legal descriptions obtained from a municipality or BC Assessment Authority may not be accurate or up-to-date. To ensure accuracy, verify the description against Land Title Office records before filing. Cost of a title search by Land Title Office staff is $9.00 (June, 1999). Paragraph 2 Paragraph 2 describes the work done and/or material supplied. Provide a brief but accurate description. Ensure the service described does in fact result in a builders lien. For example, you cannot file a claim of lien for unpaid real estate fees. Paragraph 3 Paragraph 3 requires that the person in default (the one who owes the money) be identified. This is generally the person or company who hired or contracted with the lien claimant. If that person is a company, accurately describe the company. Paragraph 4 Paragraph 4 identifies the amount owing and the date on which it became due to the lien claimant. Only include the amount that is owing. Do not include any payment amounts already received for materials or service. A lien may also be claimed for an amount which is not yet due and owing. This occurs when materials or services have been provided with payment due at a later date. In this example, paragraph 4 should identify the date when the amount will become due and owing. Paragraph 5 Paragraph 5 requires an address for service. This is the address to which subsequent documents will be directed. 9

10 Example 3: Filing a claim of lien against multiple titles FORM 5 Builders Lien Act - (Sections 15, 16, 18) CLAIM OF LIEN I, Walter Waters [ claimant ] of [ address ] 1234 Water Street, New Westminster, British Columbia [ if claim is made by an agent, insert here agent of the lien claimant ] state that: Legal Description (Multiple Titles) 1. Walt s Drywall Services Ltd., Inc. No [ claimant ] of [ address] 1234 Water Street, New Westminster, British Columbia claims a lien against the following land: Over for Sample Schedule 2. A general description of the work done or material supplied, or to be done or supplied, or both, is as follows: Provision and installation of drywall materials and related services 3. The person who engaged the lien claimant, or to whom the lien claimant supplied material, and who is or will become indebted to the lien claimant is: Upscale Construction Ltd. 4. The sum of $25,000 is or will become due or owing to Walt s Drywall Services Ltd. on January 1, 2000 [ Month, day, year ]. 5. My address for service is: 1234 Water Street New Westminster, British Columbia A1B 2C3 Signed: Walter Waters [ Month, day, year ] February 1, 2000 NOTE: Section 45 of the Builders Lien Act provides as follows: 45 (1) A person who knowingly files or causes an agent to file a claim or lien containing a false statement commits an offence. (2) A person who commits an offence under subsection (1) is liable to a fine not exceeding the greater of $2,000 or the amount by which the stated claim exceeds the actual claim. 10

11 Explanatory notes Legal Description (Multiple Titles) Paragraph 1 Filing a claim of lien against multiple titles follows the same procedure as filing against a single title. However, each title affected by such a claim must be identified by their individual legal description on Form 5. A fee of $5 is assessed against each title identified under the claim. In cases where there is insufficient space on the form, it is necessary to attach a schedule identifying each parcel (see sample schedules below). Sample Schedule1 PID Lot 3, Block 4, District Lot 5 New Westminster Land Registration District, Plan PID Lot 4, Block 4, District Lot 5 New Westminster Land Registration District, Plan PID Lot 5, Block 4, District Lot 5 New Westminster Land Registration District, Plan PID Lot 6, Block 4, District Lot 5 New Westminster Land Registration District, Plan PID Lot 7, Block 4, District Lot 5 New Westminster Land Registration District, Plan Explanation: This sample schedule would be used when the lien claimant provides material or services under a single contract for a development covering numerous parcels of land (eg, a townhouse development over 5 separate parcels of land). In this circumstance, section 16 of the Builders Lien Act permits the lien claimant to file a single lien against each parcel of land embraced by the contract. Filing fee $25.00 (5 x $5.00). Sample Schedule 2 Strata Lots 1 to 5 (inclusive) Lot 3, Block 4, District Lot 5 New Westminster Land Registration District, Strata Plan LMS7777 Strata Lot 1 Parcel Identifier: Strata Lot 2 Parcel Identifier: Strata Lot 3 Parcel Identifier: Strata Lot 4 Parcel Identifier: Strata Lot 5 Parcel Identifier: Explanation: This sample schedule would be used where services or materials are provided in relation to the common area of a strata property (eg, hallway carpeting in a 5 unit condominium). There is no separate title to the common area. Rather, title is shared by the owners of the strata lots. The claim should identify each strata lot. Filing fee $25.00 (5 x $5.00). Note: These are only two examples where an attached schedule would be required to complete a claim of lien against multiple parcels of land. There are several other examples where schedules would also be required. If in doubt, consult the Builders Lien Act or seek legal advice. 11

12 Example 4: Cancelling a claim of lien following payment or settlement LAND TITLE ACT FORM C (Section 219.9) Province of British Columbia GENERAL INSTRUMENT (This area for Land Title Office use) Page 1 of 1 pages 1. Application: (Name, address, phone number and signature of applicant, applicant s solicitor or agent) June Juniper 1234 Flower Street New Westminster, BC V1W 2X3 June Juniper Applicant (604) Parcel Identifier(s) and Legal Description(s) of Land:* PID LEGAL DESCRIPTION Lot 3, Block 4, District Lot 5, New Westminster District, Plan Nature of interest:* DESCRIPTION DOCUMENT REFERENCE (page and paragraph) PERSON ENTITLED TO INTEREST Discharge of Claim of Builders Lien No. BM N/A Registered Owner 4. Terms: Part 2 of this instrument consists of (select one only) (a) Filed Standard Charge Terms ( ) D.F. NO. (b) Express Charge Terms ( ) Annexed as Part 2 (c) Release ( X ) There is no Part 2 of this instrument A selection of (a) includes any additional or modified terms referred to in item 7 or in a schedule annexed to this instrument. If (c) is selected, the charge described in item 3 is released or discharged as a charge on the land described in item Transferor(s):* Walt s Drywall Services Ltd. (No ) 6. Transferee(s): (including postal address(es) and postal code(s))* Registered Owner, 100 Market Street, Vancouver, BC, V1W 2Z3 7. Additional or Modified Terms:* NIL 8. Execution(s):** By signing this document you are affecting the land in the manner described in item 3. Officer Signature(s) Execution Date Party(ies) Signature(s) A.D. Vocate Y M D Walt s Drywall Services Ltd. Alex D. Vocate, Notary Public 123 Old Bailey Road Vancouver, BC V1W 2Y3 (No ) Walt Waters by its authorized signatory OFFICER CERTIFICATION: Your signature constitutes a representation that you are a solicitor, notary public or other person authorized by the Evidence Act, R.S.B.C. 1979, c. 116, to take affidavits for use in British Columbia and certifies the matters set out in Part 5 of the Land Title Act as they pertain to the creation of this instrument. * If space insufficient, enter See Schedule and attach schedule in Form E. ** If space insufficient, continue executions on additional page(s) in Form D. 12

13 Explanatory notes cancelling a claim of lien using Form C (Land Title Act) Form C (Land Title Act) is used to cancel a claim of lien with the agreement of the lien claimant. This normally occurs when the claim has been satisfied and the lien claimant has agreed to sign Form C as part of the settlement. 1. Application The applicant will normally be the owner of the land against which the lien has been registered, or an agent or solicitor applying on behalf of the owner. In this example, the owner (June Juniper) is the applicant. 2. PID/Legal Description 3. Nature of Interest This area requires a full legal description of the land against which the lien has been registered. In this example, PID / Legal Description Lot 3, Block 4, District Lot 5, New Westminster District, Plan This area sets out the nature of the interest being transferred by this document. In this example, it is the Discharge of Claim of Builders Lien No. BM The number of the claim to be discharged will be recorded on the title to the property. 4. Terms Mark with an (X) the area which specifies that there is no Part 2 of this document. 5. Transferor(s) This area sets out the identity of the lien claimant. In this example, Walt s Drywall Services Ltd. 6. Transferee(s) This area identifies the person who receives a benefit (ie, discharge of a claim of lien) under this document. It is sufficient to specify the Registered Owner, along with a mailing address and postal code. 7. Additional Terms Input NIL. 8. Executions Officer Signature - The Land Title Act requires that the signature of the lien claimant be witnessed by a lawyer, notary public or other person authorized to take affidavits. Execution Date - Input the date the document is signed. Complete in the format shown. Party(ies) Signature(s) - This area is signed by the lien claimant. The name of the lien claimant should be the same as on the original claim. 13

14 Example 5: Cancelling a claim of lien for failure to take enforcement proceedings LAND TITLE ACT FORM 17 (Section 154, 155(1), 241) APPLICATION Note: Before submitting this application for interests under (1) and (2), applicants should check and be satisfied with the tax position, including taxes of the provincial and municipal governments and improvement, water and irrigation districts. NATURE OF INTEREST: (1) FEE SIMPLE ( ) MARKET VALUE: PARCEL IDENTIFIER NO.(S): (2) CHARGE ( ) PARCEL IDENTIFIER NO.(S): NATURE OF CHARGE: (3) CANCELLATION OF CHARGE ( X ) Claim of Builders Lien No. BM NATURE AND NUMBER OF CHARGE CANCELLED Lien extinguished by expiration of time. Section 25(1)(a), 33(1) HEREWITH FEES OF: $ NIL As to (1) and (2) ADDRESS of person entitled to be registered as owner if different than shown in instrument: As to (3) FULL NAME of person entitled to cancellation who or on whose behalf the application is made: June Juniper LEGAL DESCRIPTION, if not shown in instrument being submitted with this application: PID / Lot 3, Block 4, District Lot 5, New Westminster District, Plan FULL NAME, ADDRESS, TELEPHONE NUMBER of person presenting application: June Juniper, 1234 Flower Street, New Westminster, BC V1W 2X3 (604) June Juniper SIGNATURE OF APPLICANT OR SOLICITOR OR AUTHORIZED AGENT 14

15 Explanatory notes cancelling a lien using Form 17 (Land Title Act) If an action (such as filing a Certificate of Pending Litigation, Form 31, Land Title Act) to enforce a claim of lien is not initiated within one year, an owner may apply to the Land Title Office to have the claim cancelled. Items (1) & (2) Item (3) Leave blank. Cancellation of Charge - Mark with an ( X ). Indicate reason for cancellation (ie, lien extinguished by expiration of time). The reason must be included. Nature and Number of Charge Cancelled - Input the builders lien claim number assigned by the Land Title Office at time of filing (BM ) Herewith Fees of: As to (1) and (2) As to (3) There is no fee for cancelling a claim of lien. Input NIL. Leave blank. Insert full name of registered owner. In this example, June Juniper. Legal Description The legal description includes the Parcel Identification Number ( ) and a plan number (Lot 3, Block 4, District Lot 5, New Westminster District, Plan 67890). Full Name, Address This is generally the owner or an agent of the owner. In this example, the owner (June Juniper) is presenting the application. Include full name, street address, postal code and phone number. 15

16 BUILDERS LIEN ACT FORM 5 (Sections 15, 16, 18) CLAIM OF LIEN I, [ claimant ] of [ address] British Columbia [ if claim is made by an agent, insert agent of the lien claimant ] of [address ], British Columbia state that: 1. [ claimant ] of [ address] British Columbia claim a lien against the following land: 2. A general description of the work done or material supplied, or to be done or supplied, or both, is as follows: 3. The person who engaged the lien claimant, or to whom the lien claimant supplied material, and who is or will become indebted to the lien claimant is: 4. The sum of $ is or will become due and owing to on [ Month, day, year ]. 5. My address for service is Signed: [ Month, day, year ] NOTE: Section 45 of the Builders Lien Act provides as follows: 45 (1) A person who knowingly files or causes an agent to file a claim or lien containing a false statement commits an offence. (2) A person who commits an offence under subsection (1) is liable to a fine not exceeding the greater of $2,000 or the amount by which the stated claim exceeds the actual claim. 17

17 LAND TITLE ACT FORM C (Section 219.9) Province of British Columbia GENERAL INSTRUMENT (This area for Land Title Office use) Page 1 of pages 1. Application: (Name, address, phone number and signature of applicant, applicant s solicitor or agent) 2. Parcel Identifier(s) and Legal Description(s) of Land:* 3. Nature of interest:* DESCRIPTION DOCUMENT REFERENCE (page and paragraph) PERSON ENTITLED TO INTEREST 4. Terms: Part 2 of this instrument consists of (select one only) (a) Filed Standard Charge Terms ( ) D.F. NO. (b) Express Charge Terms ( ) Annexed as Part 2 (c) Release ( ) There is no Part 2 of this instrument A selection of (a) includes any additional or modified terms referred to in item 7 or in a schedule annexed to this instrument. If (c) is selected, the charge described in item 3 is released or discharged as a charge on the land described in item Transferor(s):* 6. Transferee(s): (including postal address(es) and postal code(s))* 7. Additional or Modified Terms:* 8. Execution(s):** By signing this document you are affecting the land in the manner described in item 3. Officer Signature(s) Execution Date Party(ies) Signature(s) Y M D by its authorized signatory OFFICER CERTIFICATION: Your signature constitutes a representation that you are a solicitor, notary public or other person authorized by the Evidence Act, R.S.B.C. 1979, c. 116, to take affidavits for use in British Columbia and certifies the matters set out in Part 5 of the Land Title Act as they pertain to the creation of this instrument. * If space insufficient, enter See Schedule and attach schedule in Form E. ** If space insufficient, continue executions on additional page(s) in Form D. 19

18 LAND TITLE ACT FORM 17 (Section 154, 155(1), 241) APPLICATION Note: Before submitting this application for interests under (1) and (2), applicants should check and be satisfied with the tax position, including taxes of the provincial and municipal governments and improvement, water and irrigation districts. NATURE OF INTEREST: (1) FEE SIMPLE ( ) MARKET VALUE: PARCEL IDENTIFIER NO.(S): (2) CHARGE ( ) PARCEL IDENTIFIER NO.(S): NATURE OF CHARGE: (3) CANCELLATION OF CHARGE ( ) _ NATURE AND NUMBER OF CHARGE CANCELLED HEREWITH FEES OF: $ As to (1) and (2) ADDRESS of person entitled to be registered as owner if different than shown in instrument: As to (3) FULL NAME of person entitled to cancellation who or on whose behalf the application is made: LEGAL DESCRIPTION, if not shown in instrument being submitted with this application: FULL NAME, ADDRESS, TELEPHONE NUMBER of person presenting application: SIGNATURE OF APPLICANT OR SOLICITOR OR AUTHORIZED AGENT 21

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