Environment and
Sustainable Resource Development
Form C - Consent of Occupant
I/We,
of
in the Province of Alberta, IN CONSIDERATION of the sum of $
dollars
paid to me (us) by the pipeline operator, receipt of which is hereby acknowledged, and in
consideration of the covenants and agreements hereinafter mentioned and on the part of the
pipeline operator to be kept, observed and performed:
I/We,
DO HEREBY CONSENT to the pipeline operator, its successors and assigns, its contractors,
subcontractors, servants and agents the right, license, liberty, privilege and easement to enter
upon, over, under and through all those portions of:
(the lands described in the lease, licence, permit) numbered
dated the
day of
,
, and made between Her Majesty the Queen in right of
the Province as represented by the Minister of Environment and Sustainable Resource
Development as Grantor and me (us) as Grantee at any time and from time to time with vehicles
and equipment for the purposes permitted by the Public Lands Administration Regulation and
any regulations passed in substitution therefor.
THE PIPELINE OPERATOR HEREBY COVENANTS AND AGREES to compensate me
(us) for damage done to my (our) buildings, growing crops, fences and livestock on the said land
by reason of the exercise of the rights hereby granted.
If my (our) right to occupy the said land terminates for any reason, this consent and
covenants and agreements herein contained shall then and in that event cease and determine.
This consent is given under my (our) hand expressly for the purpose of satisfying the
requirements of Section 12 of the Surface Rights Act or any other relevant or applicable
legislation.
This consent shall be binding upon and shall enure to the benefit of my (our) heirs,
executors, administrators and assigns.
IN WITNESS WHEREOF I/WE, have executed this consent at
in the Province of Alberta, this
day of
, 20
.
SIGNED AND DELIVERED
OCCUPANT
by
In the presence of:
OCCUPANT
WITNESS
This consent is hereby acknowledged and
accepted by the pipeline operator.
Per:
Personal information in this form is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act and will be used to administer
the Public Lands Act and its associated regulations. This form is a public record and is available to anyone. All information contained on this form (including personal information)
may be disclosed by Alberta Environment and Sustainable Resource Development to anyone requesting a copy in accordance with sections 166-167 of the Public Lands
Administration Regulation. For further information about the collection and use of this information, please contact 780-427-3570.
September 2013
Form C - Consent of Occupant
Page 1 of 1
© 2013 Government of Alberta