Form 74T.1- page 1 File No.

__________________

THE QUEEN’S BENCH

_____________________ Centre

AFFIDAVIT OF EXECUTION OF RENUNCIATION

IN THE MATTER OF THE ESTATE OF _____________________________________________, deceased.

I, ______________________________________, of the _______________________________________,

___________________________, MAKE OATH AND SAY:

(occupation)

1. That I was personally present and did see the within (or annexed) renunciation 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 renunciation was signed by the party at the ___________________________ of

___________________________________.

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

(If the party is a marksman, add)

5. That before signing, the renunciation 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: ___________