Affidavit of Purchaser

In the matter of the Real Property Assessment Act , R.S.P.E.I. 1988, Cap. R-5

and the Real Property Transfer Tax Act 2005

The Parcel Number applied to the real property is

(or the real property is part of Parcel Number	).

I,	, of

in the county of	, in the province (state) of	.

Make oath and say as follows:

1.	That I am the purchaser (or the agent of the purchaser) of the real property hereinafter described.

2. (a)	Purchaser's Name(s)

Street Address (PO Box, RR etc.)

Municipality

Province/State	Postal Code

2. (b)	To whom is the Notice of Assessment and Notice of Property Charges to be sent?

(If different from # 2(a))

Name

Street Address (PO Box, RR etc.)

Municipality

Province/State	Postal Code

3.	That the full name of the vendor of the real property is:

4.	That the real property purchased or to be purchased is located at: (Civic Address)

Street Number and Name

Community

County

5.	That the true consideration paid for the purchase of the real property including mobile homes (excluding

consideration paid for personal property or chattels) is	.

6.	Is this purchase subject to the Real Property Transfer Tax Act? □ Yes □ No

If No, please give reason for exemption	.

Sworn to before me at	,	)

)

in	County, in the province	)

)

(state) of	,	)

)

this	day of	,	)

)

AD 20	)

)

)

)

A notary public or a commissioner for taking affidavits in the	) Purchaser (or agent)

Supreme Court or a notary public in and for the province	)

(state) of	December 2011 11PT15-30749