Human Rights Complaint as filed



BC Human Rights Tribunal
Complaint Form
When I showed this list of people who filed the Human Rights Complaint to reporters, the rather curious reaction was that we could hardly be called a bunch of whiners or complainers.

COMPLAINANTS MEDICAL PROFILE
  1. male 83 stroke, quadruple bypass, limited mobility, limited breathing
  2. male 93 stroke, heart attack
  3. female 77 3 heart attacks, 1 stroke, diabetic (brittle)
  4. female 57 spinal/pelvic malalignment, fibromyalgia, asthma, glaucoma, insomnia
  5. female 79 heart attack
  6. female 52 anxiety depression, silicone poisoning, chronic infections, allergies
  7. female 55 asthma, sleep apnea,
  8. female 63 ptsd/anxiety, fibromyalgia, sleep apnea, suicidal depressions
  9. male 88 emphysema, chemical sensitivity, lung cancer,
  10. female 73 rheumatoid arthritis, osteoporosis, hypothyroidism, moved 3 times
  11. male 85 diabetes, chronic cough, going blind, eyes burn
  12. female 53 allergies to formaldehyde, anxiety, depressions
  13. female 75 primary pulmonary hypertension, heart and lung disease,
  14. female 52 stroke, sleep apnea, limited mobility
  15. female 60 environmental chemical sensitivity, anxiety
  16. female 82 heart attack
  17. female 69 anxiety


  1. Respondents
  1. Kiwanis Club of White Rock, operating Kiwanis Park Place
    through Crescent Housing Society, and Manager Janet Furcht
  2. Her Majesty the Queen in the Right Province of British Columbia
  3. BC Housing – Corporate Services, Shayne Ramsay, CEO
  4. BC Housing, Fraser Region, Regional Director Darin Froese
  5. Ministry of Employment and Income Assistance, and Disability section
  6. Ministry of Forests and Range (and Minister Responsible for Housing)
  7. Ministry of Health
  8. Fraser Health Authority
  9. City of Surrey
This claim asks for an immediate resolution for tenants suffering from unwanted drifting second-hand smoke (SHS) in terms of designating a smoke-free wing that will gradually grow into smoke free floors and buildings, within a timely period given the threat to health.
  1. Area of Discrimination
  • Services
  • Tenancy
  1. Grounds of Discrimination
  • Services
    • physical disability
    • mental disability
  • Tenancy
    • physical disability
    • mental disability
  1. Details of the Discrimination: What happened? Background.
  1. The Board and Management of Crescent Housing Society operate Kiwanis Park Place providing the services of accommodation to seniors and persons with disability at market value, and with subsidies received through BC Housing.
  1. This Human Rights complaint from tenants of Kiwanis Park Place outlines how a significant number of tenants experience serious health problems due to second-hand smoke seeping internally and externally into their apartments from adjoining apartments, patios, balconies, pathways, and courtyards.
  2. A significant number of tenants with serious health problems have had their health matters exacerbated through drifting second-hand smoke.
  3. The second-hand smoke comes from cigarettes, and has also come from marijuana and crack cocaine.
  4. The Board of Directors of the Society were aware of use and even trafficking in illegal substances and drugs on premises as stated in the attached notice to tenants and guests dated November 29, 2006.
  5. While a smoker tenant moving into Suite #304 the week-end of March 29th 2008 brought the current matter into the spotlight for many, the matter of drifting second-hand smoke creating and aggravating health matters is long standing. How long? Current tenants make reference to a decade and more.
  6. Dr. Blatherwick, former Chief Medical Health Officer, Vancouver Coastal Health, writes that “While the effects of smoking were well known as far back as the 1950's, the dangers of second-hand smoke only became fully apparent in the last two decades. Today the science is overwhelming as to the negative affects of second hand smoke. As a physician, I have no other recommendation but to tell people there is no safe level of exposure to second-hand smoke, to move, and yet the system makes this impossible.” January 2007.
  7. Dr. Blatherwick's quote speaks to the fact that drifting second-hand smoke was long dismissed as a problem, often characterized as a personal problem between tenants and until recently not given any credibility, except in the workplace. The current credibility given the topic emerges from recent government initiatives and favorable Human Rights judgements. Now we know better. The time has come for changes.
  8. Non-Smokers accommodate smokers by avoiding smoky people, social functions, and common areas, or quietly tolerating as best they can. Those non-smokers who openly object continue to be thought of as intolerant of smokers, and prone to exaggeration.
  1. The knowledge of the health hazards of second-hand smoke is long standing. Management and board thinking that this is not under their authority to address, is long standing.
  2. What needs anchoring up front in readers minds, is that many tenants are afraid to complain about this issue and have been suffering in silence for years for fear of being evicted, creating disharmomy, and creating conflict.
  3. People who do make management aware of the extent of the problem are not responded to in a timely manner, and often disregarded.
  4. Many people become shut down, or labelled whiners and complainers. The issue is not responded to, and therefore exists in perpetuity.
  5. Whether the fear of eviction is based on fact or not, as tenants commented, where you are told there is nothing more to be done, when you have no options, the next step is homelessness, so no wonder people are afraid to speak out. Add the conflict that arises from the issues, and people just don't want to be involved, and suffer silenced.
  6. For example, in the current situation when the new smoker tenant moved into Suite #304, Mandy above her in #404 was immediately impacted; Rose Marie beside her in #302 was immediately impacted, and Dawn across the hall in #305 was immediately impacted. Given that the impact of second-hand smoke for Mandy, Rose Marie and Dawn has been reported during the past year, how did this smoker get placed in a suite so close to the non-smokers? How did it come about, plunging these women and this complex into a health crisis? How is that Mandy, Dawn, and Rose Marie must consider the idea of an involuntary move to accommodate their health matters? We're shocked, appalled and dismayed that this could have happened. This situation became the forum to address the scope of second-hand smoke in this complex.
  7. Similar examples exist or existed between
    1. suites 3240 with a smoker below and beside: 3230, 2230;
    2. suites 333 with a smoker 229; and below 105;
    3. suite 208 with a smoker in 202
    4. suites 328 and 315;
    5. suite 204 across from smoker 203
    6. suite 237 with a smoker 235 beside, and below 102.
  8. Moving is a necessary consideration. However, at present as General Manager Janet Furcht advised (copies attached), there are no suites here in either building available that would give any of us a guarantee of improved circumstances of a smoke-free environment, nor might it be considered sustainable. There is no guarantee that future neighbours would be non-smokers – anywhere. For example, Mandy moved twice within this complex and had a verbal agreement from management there would not be a smoker below her. Margaret's move to Kiwanis was her third move trying to get smoke-free accommodation.
  9. Second-hand smoke from cigarettes moves beyond issues of smoking as legal: people do go out and buy cigarettes in drug stores, corner stores, food stores. Second-hand smoke confronts issues of impacting another persons health other than the smoker.
  10. Second-hand smoke is more than an infringement or breach of our quiet enjoyment. It is a health matter and poverty issue. SHS is scientifically verified as dangerous carcinogen, a cause of cancer, heart attack, respiratory illness, and a host of other illnesses and diseases, including a trigger for people who have already experienced strokes.
  11. Most of us are in receipt of rent subsidies specifically because we have a disability. We do not have the financial or physical resources to easily and readily remediate the problems confronting us in this crisis.
  12. Management's response to the petition dated April 21, 2008 stated tenants who entered into their tenancy agreements with Kiwanis Park Place, Crescent Housing Society knew of the likelihood of smokers living on the premise, and that tenants were fully aware that personal smoking was permitted, unless otherwise stipulated by public notice.
  13. Board and Management were the only people fully aware of the extent of personal smoking.
  14. For example, non-smoker tenants who moved into the building within the past year made several queries on application, in interview, in viewing the building about the extent of smoking. They made conditional demands on accepting a unit:
    1. if there was no smoking below them or beside them,
    2. if the unit had not been a smoker unit,
    3. or to place them as far away from smokers as was possible given their allergic responses to SHS.
  15. Despite this degree of assertiveness and screening, individuals were placed in suites that had been previously inhabited by smokers, and into suites that were not sufficiently cleaned or detoxed. New tenants found themselves stacked on top of smokers. In one situation, managed agreed to replace the rugs on the third day after tenancy began because of the stench from second-hand smoke.
  16. Questions from tenants, BC Housing, and from management ask, “Did we know this was not a non-smoking building?” “Why did we accept living here, under these conditions?” People new to subsidized housing could not have known the extent they would be exposed, and exposed to more smokers than ever in their life.
  17. The implied message is that we had a choice, and that we were not assertive enough in our efforts to ensure a healthy environment. Some individual's choices were mitigated by the fact they were coming from transition houses, or were facing homelessness.
  18. The matter is not just that “Kiwanis Park Place is not a non-smoking building,” it is that second-hand smoke is a non-issue. It carries no legitimacy or credibility here in this housing environment. It may be accepted in private owned condos, stratas. Ads for market based rental units readily advertise for “non-smoking tenants.”
  19. Tenants suffer drifting second-hand smoke from multiple sources into multiple suites and common areas, multiple times of the day and night.
  20. We do not accept that breathing other people’s smoke must be tolerated or endured in communal complexes, and the situation of high-density, publicly-funded multi-unit complexes exacerbates the problem.
  21. We no longer accept that because we live in public housing, subsidized housing, social housing, whatever it is called - that we must put up with a known toxic substance, as if the knowledge on the hazards does not apply to us.
  22. We no longer accept that we must put up with a known toxic substance knowingly entering our homes, or as contemptuously put, “Suck it up,” “those [non-smokers] people are just anti-social” and “it's terrible when neighbors [non-smokers] are like that” and “Just shut up. With the rent you're paying what do you expect.”
  23. We no longer accept that the individual non-smoker is the source of the problem, a personal problem, one that we must mediate through management/board with a smoker to partition smoke-free hours.
  1. The drifting second-hand smoke problem has become intolerable for many of us, and for some it has become life threatening. We request your help to resolve this problem immediately, so that we are no longer expected to endure the impact on our health, our quality of life, or resolve the problem.
  2. Second-hand smoke from adjoining units, balconies, patios, pathways, courtyards insidiously drifts and wafts into our apartments from various sources, all of which are already known and documented:
    1. outdoor walkways adjacent to patios, balconies, suites
    2. both open and closed balcony doors
    3. open and closed bedroom windows
    4. through kitchen stove fans
    5. through bathroom fans
    6. through suite entrance doors
    7. through shared ventilation systems
    8. from heating vents
    9. through electrical outlets
    10. through cracks in walls
    11. through elevators
  1. To be clear, we are not talking about a temporary whiff of second-hand smoke or a dislike of the smell.
  2. We are talking about drifting second-hand smoke that is significant in volume and density, continuous and regular as opposed to sporadic and occasional, and accumulative versus quickly disbursed. It invades not only our suites. It permeates, contaminates, and ruins our furniture, beds, pillows, closets, clothing, possessions. It fills the hallway, lobby entrances, and extends down a complete wing.
  3. Some people do not smell second-hand smoke and say they are not bothered by it. Not smelling second-hand smoke does not remove the hazards of the gases embedded in the smoke.
  4. The extent of the problem is further illustrated through examples.
    1. Some ten months ago Rose Marie #302 moved in, and Mandy #404 thought Rose Marie was a smoker, because Mandy receives SHS that we now know comes from Emma #200.
    2. Smoke from Suite #102 fills the wing and wafts into Suite #112, and extends to the small elevator on that floor, and up into the suite #237 above.
    3. As a further example, smoke from Suite #304 contaminates Suite #305 across the hall and down past through the common area to the elevator.
    4. Smoke from balcony #229 enters balcony, bedroom, and living room of #333.
  1. Many smoker tenants are conscious themselves about these effects of second-hand smoke, and they do not smoke in their own apartments. The smoke at the edge of their patios and balconies.
  2. Some smokers also attempt to ventilate their suites by holding their suite door open with a running shoe, venting the smoke into the common hallway, or out onto their patios.

  1. Second-hand smoke disrupts the public traffic spaces, the social spaces and the quiet enjoyment of our homes. The only way to get fresh air into suites is to open balcony doors and bedroom window, and this is compromises through drifting second-hand smoke.
  1. Second-hand smoke is a serious intrusion into our suites. As long as this known toxic air contaminant is polluting our air, our homes are not fully habitable day and night.
  2. We might be in receipt of rent subsidies, but we are still entitled to expect that our homes are not hazardous to our health.
  3. We note how the impact of second-hand smoke entering our apartments aggravates our existing health conditions and creates a number of other symptoms. All of us have experienced one or more of the symptoms noted below brought on by continued exposure. Moreover, if demanded, we can provide letters from our physicians confirming that the smoke infiltrating our homes is harming our health and exacerbating existing conditions and disabilities. Here are some examples of what we are experiencing:
    1. Spike in allergies triggering eye infections, itching noses, bloody noses, sinus infections with the need to take over the counter and prescription medication, and have on hand an Epipen
    2. Asthma attacks, with having to return to the use of inhalers.
    3. Rapid respiratory response with return to the use of inhalers.
    4. Aggravation of PPH primary pulmonary hypertension
    5. Ear infections with accompanying pain,
    6. Swollen lymph nodes, thyroids, hoarseness and loss of voice
    7. Development of 'smokers cough' with accompanying pressure of bladder leakage, chest tightness, and jarring of spinal vertebrae
    8. Pain emanating from excess toxic burden on liver, kidney, bladder
    9. Edema (swelling) of hands, eyes, feet
    10. Shocked awake from a sense of being choked and suffocated, and falling out of bed , racing heart
    11. aggravation, exacerbation of emphysema, and bronchitis
    12. Depression, fibromyalgia, chronic fatigue syndrome cascading into migraines with accompanying nausea and vomiting
    13. Depression, anxiety, fibromyalgia, chronic fatigue syndrome compounded from respiratory illnesses, including bronchitis
    14. Being unable to manage previously manageable chronic pain
    15. Escalation of anxiety (fear), and physical distress from attempting to address the problem, including options for moving
    16. Escalated fear from remembering how one resident dealt with breast cancer attributed to second-hand smoke, and no one believes her
    17. Increased insomnia despite medication,
    18. Seeking places to sleep outside of suites and away from late night and early morning smoking
    19. Staying outside for hours at a time to get relief from the sense that you are a smoker, from smoke taste on your own breath
    20. Distress from finding people sleeping elsewhere in the building
    21. Aggravation of glaucoma with eyes swelling, burning, and grittiness
    22. Increased hostilities between smokers and non-smokers
    23. Experience of harassment from smokers, receiving anonymous mail
    24. Unable to prepare, eat, and clean up from meals with second-hand smoke wafting down kitchen fans.
    25. Thought of suicide, called the crisis line.
  1. Second-hand smoke aggravates and exacerbates existing health conditions. It creates new health matters. This is a long-documented health fact, as demonstrated in Dr. Blatherwick's quote (see #6).
  2. Many of us have tried relentlessly to manage and cope, accommodate smoking, mitigate and rectify the problem of drifting SHS entering our homes without much success. The over-riding assumption is there is nothing more to be done.
  3. Some of us have been living with this problem for years, and some are only now experiencing the overwhelming second-hand smoke due to the proximity of new tenants who smoke. Some of the steps that residents have taken to resolve this problem include:
    1. purchase or borrow air purifiers
    2. inform and complain to management verbally, and received information about the BC Clean Air Coalition
    3. researched options on the internet on how to manage the problem
    4. accessed guidelines from the Canadian Mortgage and Housing Corporation on solving odor transfer problem in our suites
    5. opening and closing windows and balcony doors as needed (which is more than an inconvenience in the summer when it’s hot and we need fresh air, and in the winter when it is cold)
    6. shut off thermostat, and sealed heating registers with foam or plastic, and used alternative methods for heating
    7. Sealed sources of smoke, such as kitchen stove fans
    8. approached neighbours, or attempted to approach the neighbour to ask for courtesy and co-operation because of health matters, and were dismissed
    9. agreed to meetings with management/board and smoking neighbours, and tentatively agreed to partitioning time as there were no other options considered legitimate
    10. Disagreed and refused to participate in meetings facilitated by management/board to partition smoke-free time.
    11. Wrote letters to management ad nausea, to the president of the board and asking for responses, and solutions.
    12. Called provincial government officials, city officials and BC Housing,
    13. avoidance of certain hallways
    14. avoidance of certain individuals, especially in closed and small spaces, such as elevators
    15. avoidance of and stopping activities, social community
    16. staying out of their suite
    17. staying outdoors, and have considered sleeping outdoors
    18. organized a petition receiving over 40 signatures asking for an immediate resolution, where three of us spent two hours each meeting with people
    19. asked Kiwanis management and board to repond with an immediate resolution from unwanted drifting second-hand smoke
    20. as per attached letter in response to our petition, we are pursuing our group human rights complaint.
    21. Request that cold air ventilation systems work and be regularly cleaned
  1. Despite all our attempts to address the problem, the smoke permeates our living spaces to the extent that some have been forced to vacate their apartments to stay with friends to avoid the smoke. Some have slept elsewhere in the building. Some find relief in Crescent Park that surrounds the complex. The issue has now reached a crisis point.

  1. Where did it happen?
      Kiwanis Park Place, Surrey, BC.
      Bldg 2 - 12850 26th Avenue, and
      Bldg 1 - 12882 26th Ave
  1. Kiwanis Park Place administered through Crescent Housing Society provide the services of accommodation to seniors and persons with disability at market value, and with subsidies received through BC Housing.
  2. Respondents individually and systemically breached fiduciary and stewardship roles that unreasonably and adversely affected the quiet enjoyment of complainants in their homes, and seriously jeopardized the health of complainants:
    51.1 failed to accommodate claimants' health matters, and
    51.2 failed to acknowledge the problem as readily acknowledged in the health sciences for four decades, and failed to accommodate what legally has been acknowledged through Canadian Case law
    51.3 failed to acknowledge the problem as acknowledged and applied in the workplace, in health care, in hospitals, in the newspapers, prisons, cars with children, and
    51.4 failed to apply the knowledge of SHS as provider of housing to the vulnerable and disadvantaged seniors and persons with disability population they serve, many whom are financial subsidies through the Province of BC, and
    51.5 deemed the problem of SHS to be of “nuisance” value and inter-tenant conflict, resolvable by smoker versus non-smoker tenants, only between tenants, or mediated by management and board directors in terms of partitioning smoke-free hours
    51.6 deemed the problem to be of “nuisance” value rather than a breach of “quiet enjoyment” of our homes and a serious health matter
    51.7 waived away as in dismissed, and trivialized the seriousness of drifting second-hand smoke for tenants at Kiwanis Park Place against notions of 'private housing' versus public, social, subsidized housing as if the issue of smoke-free does not apply to everyone.
    51.8 failed to consider, much less acknowledge, these problems as a health matter, much less a crisis; a crisis in terms of health, finances, and ethics
    51.9 failed to acknowledge as legitimate or reign in harassment towards our persons from some staff and the few vituperative smokers, and the escalation of SHS into our suite
    51.10 Kiwanis Park Place management, who provided the information on BC Clean Air Coalition, failed to implement this information of smoke-free floors and wings proactively, to consider independent survey and mapping out of the structure of the aged building as problematic, to consider the air flow from proximity to ocean, within the population they served of seniors and persons with disabilities, creating a situation where vulnerable people felt there was no choice but to involuntarily consider moving even though there doesn't seem to be anywhere to move, and to bring about a HR claim.
    51.11 Kiwanis Park Place management failed to use their authority granted under the RTA 's sections 28 and 47 to make the transition to smoke-free housing proactively and timely these past six months, and without unreasonable disturbance.

  1. Individuals impacted by this health crisis and existing on limited funds experienced a necessity to spend and borrow money in attempt to provide immediate relief:
    52.1 purchasing of air filtration systems
    52.2 borrowing money to purchase air purifiers
    52.3 purchasing over the counter medication not covered by MSP
    52.4 purchasing new pillows
    52.5 extra laundry washing bedding, clothing with associated costs of soap, detergents
    52.6 covering the cost of carpet cleaning
    52.7 increase in the use of kleenex
    52.8 being away from the suite, and eating out
    52.9 paying for the guest suite when relations visit overnight
    52.10 duct tape, weather stripping, to seal off vents
  1. Second-hand smoke is considered of sufficient harm that the provincial government has banned smoking in all public spaces, workplaces, and hospitals to protect non-smokers in the public sphere. Why is the same knowledge and protection not being extended to people housed in provincially-funded dwellings, many who have health matters as seniors, and as certified by Persons With Disabilities designation?
  1. Given that we experienced how pervasive second-hand smoke disrupted the quiet enjoyment of our homes, stripped the quality of our lives, and made us physically ill on many levels, second-hand smoke creates a disability pursuant to the Human Rights Code, and we think you as the landlords have a responsibility to accommodate our conditions, short of undue hardship. We therefore present the following remedies for consideration:
    54.1 Conduct an immediate independent survey mapping out the smokers, and mapping out the structural aspects of problem such as the design of the building and courtyard, taking into consideration the wind dynamics coming in from proximity to the ocean and park. Comments have been made that the older building, building one might have to be designated smoke free.
    54.2 Designate a specific wing or section of the building as smoke-free and proceed immediately to move people within the building so that non-smokers will no longer be exposed to second-hand smoke.
    54.3 Designate current vacant suites as non-smoking by amending current lease, or developing a new lease stipulating no smoking by tenants, guests, service personnel on given areas of the property.
    54.4 Once a section has been designated as smoke-free, ensure that there is a reasonable time specified for the implementation date – this cannot be delayed for months or a year given the threat to people’s health.
    54.5 Organize community meetings to discuss the issue, discuss how the issue will be resolved and reassure both smokers and non-smokers that they do not have to fear being evicted.
    54.6 Conduct meetings between tenants and board/management through independent mediators.
    54.7 Offer financial incentives to smokers and non-smokers in order that moving can occur with the least amount of disruption.
    54.8 Offer support to tenants that would like to quit including free nicotine replacement therapy.
    55 Name and Address of Respondents
    55.1 Kiwanis Club of White Rock, operating Kiwanis Park Place
    through Crescent Housing Society, and Manager Janet Furcht
    12850 26th Ave, Surrey, BC. V4P 1S1
    55.2 Her Majesty the Queen in the Right Province of British Columbia
              PO Box 9041, Stn Prov Govt, Victoria, BC. V8W 9E1
    55.3 BC Housing – Corporate Services, Shayne Ramsay, CEO
    1701 - 4555 Kingsway, Burnaby, BC. V5H 4V8
    55.4 BC Housing, Fraser Region, Regional Director Darin Froese
    #800 - 5945 Kathleen Avenue Burnaby BC V5H 4J7
    55.5 Ministry of Employment and Income Assistance, and Disability section
            P O Box 9934 Stn Prov Gov Victoria, BC V8W 9R2
    55.6 Ministry of Forests and Range (and Minister Responsible for Housing)
    PO Box 9525 Stn Prov Govt Victoria, BC. V8W 9C3
    55.7 Ministry of Health
            PO Box 9050, Stn Prov Govt, Victoria, BC. V8W 9E2
    55.8 Fraser Health Authority 300, 10334 - 152A Street Surrey BC V3R 7P8
    55.9 City of Surrey 14245 - 56th Avenue Surrey, BC V3X 3A2
    56 Name and Address of Claimants
      Elsie L. Cormack
      #4150 12850 26th Ave. Surrey, BC. V4P 1S1 542-1829
      Mandy Neufeld
    #404 12882 26th Ave, Surrey, BC. V4P 1R9 538-1318
      Rose Marie Borutski
    #302 12882 26th Ave, Surrey, BC. V4P 1R9 538-1854

      Linda Chandler
      #333 12882 26th Ave, Surrey, BC. V4P 1R9 538-3040

      Dorothy Watson
      #344 12882 26th Ave, Surrey, BC. V4P 1R9 538-6203
      Herb Watson
      #344 12882 26th Ave, Surrey, BC. V4P 1R9 538-6203
      Henry Hamm
      #328 12882 26th Ave, Surrey, BC. V4P 1R9 541-8946
      Barb Hamm
      #328 12882 26th Ave, Surrey, BC. V4P 1R9 541-8946
      Florentine Brunklaus
      #3210 12850 26 Ave, Surrey, BC. V4P 1S1 536-4019
      Trudy Thompson
      #418 12882 26th Ave, Surrey, BC. V4P 1R9
      Lorraine Tumman
      #232 12882 26th Ave, Surrey, BC. V4P 1R9 541-9371
      Margaret L. MacLeod,
      #3240 12850 26th Ave, Surrey, BC. V4P 1S1 538-9738
      Denis Lee
      #5100 12850 26 Ave, Surrey, BC. V4P 1S1 536-4577
Rosemary Hancock
204 - 12882 26th Ave, Surrey, BC. V4P 1R9 538-2973
Ted Kopp,
#1100 12850 26th Ave, Surrey, BC. V4P 1S1 538-7280
Joan Murphy,
#208 12882 26th Ave, Surrey, BC. V4P 1R9 538-2468
Pat Easterbrook,
#309 12882 26th Ave, Surrey, BC V4P 1R9 541-8405
    Signatures and Dated
    I declare the above information is true to the best of my knowledge. I understand that a copy of this form will be sent to the Respondents.




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