| Form B. | Affidavit in support of an Application for Entry for a Homestead, a
Pre-emption of a Purchased Homestead.
I, _________________________________
of ____________________________________ do solemnly swear,(or affirm, as the case may be)
that I am over eighteen years of age; that to the best of my knowledge and belief the land in respect of
which my application is made is agricultural land and open to entry, and that there is no person residing
on the said land; that there are no improvements thereon; that this application is made for my exclusive
use and benefit, with the intention of my residing upon and cultivating the said land, and neither directly
nor indirectly for the use or benefit of any other person or persons whomsoever.
(2.) That I have not heretofore obtained an Entry for a Homestead on Dominion Lands.
(3.) That I obtained Entry for a Homestead on the _____________________________________
day of _______________, 19 _ _ for _______________ Quarter-section of
Section _______________, Township _______________ Range _______________
of the _______________ Meridian, but forfeited ( or abandoned, as the case may be) the same.
(4.)That this application is made for my exclusive use and benefit, with the intention of my residing
upon and cultivating the said land, and neither directly nor indirectly for the use or benefit of any other
person or persons whomsoever.
(5.) That my homestead entry is in good standing at this date.
| Sig. ______________________________
| Subscribed and sworn to this ______________________________
day of ______________________________ 19 _ _
before me at ______________________________
Local Agent,
[or Sub-Agent as the case may be.]
NOTE-Strike out paragraph 2 if applicant has already received homestead entry.
NOTE-Paragraph 5 is applicable only in the case of an application for a pre-emption entry.
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