FORM 54A

CONFIRMATION DATE ALTERATION AGREEMENT

(General Heading — Form 4A or 4B)

CONFIRMATION DATE ALTERATION AGREEMENT

The parties agree that the report of (name of associate judge) dated is deemed to be confirmed as of and not as of , the deemed confirmation date set out in the report.

(Date)	(Petitioner)

(Name, address and telephone number of party or lawyer for party)

(Witness if signed by the party)

(Respondent)

(Name, address and telephone number of party or lawyer for party)

(Date)

(Witness if signed by the party)

(Complete the Affidavit of Execution if agreement

is signed by party)

I, , of the of in the Province of Manitoba, MAKE OATH (AFFIRM) AND SAY:

1.	THAT I was personally present and did see execute the attached Confirmation Date Alteration Agreement.	(name of party)

2.	THAT I know and am satisfied that is the full age of 18 years.
(name of party)

3.	THAT the Confirmation Date Alteration Agreement was executed at in .

SWORN (AFFIRMED) before me

at the of	)

in the Province of	)

this day of .	)

)	(Signature of Witness)

)

)

A Commissioner for Oaths in and for the

Province of Manitoba.

My Commission expires: