Form 74T.1 - page 1 File No.

__________________

THE QUEEN’S BENCH

_____________________ Centre

AFFIDAVIT OF EXECUTION OF CONSENT TO WAIVER OF BOND

IN THE ESTATE OF ______________________________________________________, deceased.

I, _________________________________, of the ______________ of ___________________ in

the Province of Manitoba, ___________________________, MAKE OATH AND SAY:
(occupation)

1. That I was personally present and did see the within (or annexed) consent to waiver of bond duly
signed by __________________________________, the party therein named.
2. That I know the party so signing and that he / she is of the full age of 18 years.

3. That the consent to waiver of bond was signed by the party at the _________________ of

_____________________, in the Province of Manitoba.

4. That I am a subscribing witness to the signatures.

(If the party is a marksman, add)

5. That before signing, the consent to waiver of bond was read over and explained to

________________________ who appeared to understand the same and made his / her mark

thereto in my presence.

Sworn (or Affirmed) before me at the

__________ of __________________
in the Province of Manitoba,
this _____ day of __________, _____

______________________________
Signature
_______________________________
Deputy Register for Queen’s Bench or
A Commissioner for Oaths in and for
The Province of Manitoba
My Commission expires: ___________