Surface Memorandum of Surrender

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Indian Oil and Gas Canada

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

Memorandum of 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 Contract.

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 the 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 Surrender ("MOS") must be submitted for approval.

- 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 to Indian Oil and Gas Canada, 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 by ________________________________________.
  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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