Surface Memorandum of Partial Surrender

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Indian Oil and Gas Canada

(Section 44 – Indian Oil and Gas Regulations, 1995)

Memorandum of Partial Surrender

to the Government of Canada

IN THE MATTER OF Surface Agreement No.
[OS- ___, TS-___, FS-___, RW-___, TW-___ or FW-___ ]
dated [Date] ("Contract") covering the lands therein described.

The undersigned, as [Lessee or Grantee], in the said Contract, hereby for good and sufficient consideration, unconditionally releases, surrenders and quitclaims unto the Government of Canada, its entire right, title, estate in the lands listed below:

[Describe lands surrendered]

IN WITNESS WHEREOF [Corporate Name] has caused these presents to be executed, this ___ day of __________ 200__.

 

[CORPORATE NAME]

 

____________________

____________________
Witness

____________________

This surrender is effective as of the ___ day of __________ 200__ ("Effective Date"). (Note: The Effective Date shall be determined by Indian Oil and Gas Canada and is the date surface reclamation is approved).

APPROVED AS OF THE EFFECTIVE DATE:

GENERAL MANAGER, LAND
INDIAN OIL AND GAS CANADA

____________________

NOTE:

- Four originals of the Memorandum of Partial Surrender ("MOPS") must be submitted for approval.

- In accordance with Schedule II of the Indian Oil and Gas Regulations, 1995, a $25.00 fee must be submitted, payable to the Receiver General for Canada.

- Lessee/Grantee shall affix its corporate seal or the signature shall be witnessed by at least one person who is not a party to the Contract, and the attached affidavit of witness completed before a notary public. If executed by power of attorney Lessee/Grantee shall also provide original power of attorney documentation, if not previously provided.

Affidavit of Witness

re: Execution (Signing) of Document

Canada Province of _______________

I ______________________________

of the City of ____________________

of the Province of ________________

to Wit

Make Oath and Say

  1. That I was personally present and did see the attached instrument duly executed __________________________________________.
  2. That I know the said party(ies), and that the said party(ies) in my belief is/are the full age of majority for the Province of _______________.
  3. That I am the subscribing witness to the said instrument.

Signature of Witness __________________________________________.

SWORN before me at the City of _______________, Province of _______________,

this _______________ day of _______________, ___________ .

________________________________________.

A Notary Public, or a Commissioner for taking Oaths, in and for the Province of _______________.

My commission expires: _______________.

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