Alberta Affidavit Verifying Notice Form

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Affidavit Verifying Notice Personal Property Security Regulation Section 66(1)

I, of in the Province of

,

Postal Code

make oath and say: 1.

That I have been authorized by the secured party to act as an agent for the purpose of effecting registration of notices relating to a security interest in a fixture or crop on the land described in the attached notice.

2.

That I have full knowledge of the facts set out in the attached notice and the statement of facts is true.

Sworn before me

this

day

day of

month

,

year Signature of Agent

at

REG3334 (2013/03)

Reset

, Alberta.

Registry Agent Office Use Only

Date of Submission (yyyy-mm-dd)

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