APPLICATION TO REGISTER A PLAN TO REFLECT A CHANGE IN NATURAL BOUNDARIES (S. 61) (as A PLAN OF SUBDIVISION (s. 76 and 77), IF APPLICABLE)

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APPLICATION TO REGISTER A PLAN TO REFLECT A CHANGE IN NATURAL BOUNDARIES (S. 61 (as A PLAN OF SUBDIVISION (s. 76 and 77, IF APPLICABLE ***NOTE: IF A SURVEY PLAN BEING SUBMITTED UNDER S. 61 OF THE LAND TITLES ACT, 2015, INVOLVES MORE THAN ONE REGISTERED OWNER, APPLICATIONS FROM EACH REGISTERED OWNER WILL NEED TO BE SUBMITTED TOGETHER AS ONE PACKAGE FOR SURVEY PLAN REGISTRATION PURPOSES*** TO THE REGISTRAR: Applicant(s: (print full name of registered owner(s and tenancy type shown on current Certificate of Title Agent: (print full name of agent if different than Applicant(s Mailing Address to be shown on new title: Current Legal Description(s: New Legal Description(s: The following documents must be submitted with this Application: 1. Evidence that a change in natural boundaries occurred as a result of an accretion, erosion, or other natural occurrence [s. 61(b (i] is attached as SCHEDULE A - Surveyor s Report. [*Please Note: applicants or their surveyor are advised to seek a pre-screening of the suitability of a s. 61 application in their circumstances, before an application is submitted to Land Titles Office for registration. Please contact the Surveyor General Branch for this pre-screening]. RO: 5 Page 1 of May 11, 2017

2. Written consent of the registered owner(s of the land. [s. 61(b (i] Execution of this application and/or the plan, defined below, is evidence of the written consent of the registered owner(s of the land; or Consents attached. 3. Written consent of the registered owner(s of any other parcels of land that may be adversely affected by the amendment of the boundaries and the legal description of such lands [s. 61(b (ii (B] is attached as SCHEDULE B Satisfied by having all registered owners adversely affected signing the survey plan, submitted with this Application; or Consents attached. 4. Approval of the Survey Authority [s. 61(b (iii] This is evidenced by the approval of the survey plan, submitted with this Application; or Approval attached. 5. The consent of the Commissioner [s. 61(b (iv] is attached as SCHEDULE C [*Please Note: applicants or their surveyor are advised to seek a pre-screening of the suitability of a s. 61 application in their circumstances, before an application is submitted to Land Titles Office for registration. Please contact the Surveyor General Branch for this pre-screening]. 6. The consent of any Yukon First Nation that has settlement lands adjoining the original boundary of the parcel [s. 61(b (v] is attached as SCHEDULE D No Yukon First Nation settlement lands adjoin the original boundaries; or Consents attached. 7. Any consents required under the Federal Real Property and Federal Immovables Act or any other Act of Canada [s. 61(b (vi] is attached as SCHEDULE E No consents required in this case; or Consents attached; 8. Consents of any encumbrancees holding a registered mortgage/encumbrance against the land is attached as SCHEDULE F There are no encumbrances in this case; or Consents attached. RO: 5 Page 2 of May 11, 2017

I/WE REQUEST THAT YOU: (a register the survey plan; (b cancel the certificate(s of title number(s: (or attach list; and (c issue a new certificate of title for each parcel shown on the plan in the name of the owner(s named on the current certificate of title(s. If this Application has been signed by an agent, the agent warrants that he or she has the authority to sign. SWORN / AFFIRMED BEFORE ME at in on the day of, 20 (Signature of Notary or Commissioner (print full name Notary Public in and for Yukon; or Notary Public or Commissioner for Oaths in and for (My commission expires: (Signature of Applicant or Agent (print full name of Applicant or Agent (Signature of Applicant (if more than one (print full name of Applicant * All Notaries and Commissioners outside of Yukon must affix seal RO: 5 Page 3 of May 11, 2017

SCHEDULE A [Surveyor s Report] RO: 5 Page 4 of May 11, 2017

SCHEDULE B [Consent(s of registered owners adversely affected by the amendment of the boundaries and legal description of such lands] RO: 5 Page 5 of May 11, 2017

SCHEDULE C [Consent of the Commissioner to be provided by Lands Planning Branch or Lands Management Branch] RO: 5 Page 6 of May 11, 2017

SCHEDULE D [Consent(s required by any Yukon First Nation in the case that there are settlement lands involved] RO: 5 Page 7 of May 11, 2017

SCHEDULE E [Consents required under the Federal Real Property and Federal Immovables Act or any other Act of Canada] RO: 5 Page 8 of May 11, 2017

SCHEDULE F [Consents of encumbrancees of any mortgage/encumbrance registered against the property] RO: 5 Page 9 of May 11, 2017