STATUTORY DECLARATION B

STATUTORY DECLARATION B

CANADA
PROVINCE OF BRITISH COLUMBIA

IN THE MATTER OF SECTION 933(5)(a) OF THE LOCAL GOVERNMENT ACT AND CITY OF LANGFORD DEVELOPMENT COST CHARGE BYLAW NO. 1401

I, ____________________, of ____________________, Langford, in the Province of British Columbia, DO SOLEMNLY DECLARE:

1. In respect of the development of land in the City of Langford I provided [insert description of DCC Project] (the "DCC Project") and I am entitled to a total credit of [insert total original DCC credit amount approved by the City] towards development cost charges for [specify park land] that may be imposed under the City's development cost charge bylaw.

2. On [insert date of payment] I received a payment of $__________ from [insert name of owner who has paid the cost of the DCC Project or a portion of the cost] (the "Contributing Owner") towards the cost of the DCC Project.

3. I make this Statutory Declaration for the purpose of requesting the City to allow a setoff of the amount specified in paragraph 2 against development cost charges that are payable by the Contributing Owner under the City's development cost charge bylaw.

4. I acknowledge that the DCC credit that I am requesting the City to allow will reduce the amount of DCC credits to which I am entitled under Section 933(8)(a) of the Local Government Act in respect of the DCC Project, by an equivalent amount.

AND I MAKE this solemn declaration, conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath and by virtue of the Canada Evidence Act.

SWORN BEFORE ME at the City of Langford, in the Province of British Columbia, this _____ day of _________, 201.

A Commissioner for Taking Affidavits in the Province of British Columbia

[insert name of owner]

[insert name of owner]