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AR 55/2001 PROVINCIAL COURT CIVIL CLAIMS FORMS REGULATION

(Consolidated up to 176/2012)

ALBERTA REGULATION 55/2001

Provincial Court Act

PROVINCIAL COURT CIVIL CLAIMS
FORMS REGULATION

Form of civil claim

1(1)  The copy of a civil claim that is retained by the Court must be in Form 1 of the Schedule.

(2)  The copy of a civil claim that is served on a defendant must be in Form 2 of the Schedule.

Form of dispute note

2   A dispute note must be in Form 3 of the Schedule.

Repeal

3   The Provincial Court Civil Division Forms Regulation (AR 317/89) is repealed.

Coming into force

4   This Regulation comes into force on April 1, 2001.

Schedule

FORM 1

Action No.    

Provincial Court of Alberta
Civil

Plaintiff


and

Defendant

Civil Claim

The Plaintiff Claims from the Defendant $____________________ _________________________ and costs of this action.  The Claim arose at ____________, Alberta on or about    (date)   .

The reasons for the Claim are:

I will be calling _________ witnesses.

o I abandon that part of my Claim that exceeds the financial jurisdiction of this Court.

I understand and agree that I cannot recover in this Court or any other court the part of my Claim that is abandoned.

The Plaintiff’s address for service is:

 

 

 

City

 

Province

 

Postal Code

 

Res. Phone

 

Bus.

Phone

The Defendant’s address is:

 

 

 

City

 

Province

 

Postal Code

 

Res. Phone

 

Bus.

Phone

The Defendant’s address is:

 

 

 

City

 

Province

 

Postal Code

 

Res. Phone

 

Bus.

Phone

Dated _____________

  ______________________________

at __________, Alberta           Signature of Plaintiff/Agent/Solicitor

   _____________________________

Print Name        

The Court’s Address is:

Website address:
  www.albertacourts.ab.ca

 

Issued by the Provincial Court of
Alberta on ________________   

_______________________

Clerk of the Provincial Court

 

FORM 2   (FRONT)

Action No.    

Provincial Court of Alberta
Civil

Plaintiff

and

Defendant

Civil Claim

The Plaintiff Claims from the Defendant $____________________ _________________________ and costs of this action.  The Claim arose at ______________, Alberta on or about    (date)  .

The reasons for the Claim are:

I will be calling _________ witnesses.

o   I abandon that part of my Claim that exceeds the financial jurisdiction of this Court.

       I understand and agree that I cannot recover in this Court or any other court the part of my Claim that is abandoned.

The Plaintiff’s address for service is:

 

 

 

City

 

Province

 

Postal Code

 

Res. Phone

 

Bus.

Phone

The Defendant’s address is:

 

 

 

City

 

Province

 

Postal Code

 

Res. Phone

 

Bus.

Phone

The Defendant’s address is:

 

 

 

City

 

Province

 

Postal Code

 

Res. Phone

 

Bus.

Phone

Dated _____________

   ______________________________

at __________, Alberta     Signature of Plaintiff/Agent/Solicitor

   _____________________________

Print Name

The Court’s Address is:

Website address:
  www.albertacourts.ab.ca

 

Issued by the Provincial Court of
Alberta on ________________   

_______________________

Clerk of the Provincial Court

 

Important Notice to Defendant on other side – TURN OVER

FORM 2   (BACK)

Notice to Defendant

Within 20 days of receiving this Civil Claim (30 days if served outside of Alberta), you must:

1    pay to the Court office the amount of the Civil Claim plus costs (contact the Court office) by cash, certified cheque, money order or debit card (if available) only.  A Court appearance will not be necessary if you choose this option.

or

2    dispute the Civil Claim by completing and then delivering the attached form of Dispute Note in person, by fax machine or by mail to the Court office at the address shown on the other side (turn over).  The Court office must receive the form of the Dispute Note within the 20‑day (30‑day) time limit.

If you do not pay or dispute the Civil Claim, judgment may be entered against you for the amount of the Claim, interest and costs.

It is your responsibility to notify the Court office of any change in your address.

FORM 3   (FRONT)

 

Action No.    

For office use only

Received at _____a.m.

p.m.

 

Provincial Court of Alberta
Civil

Plaintiff

and

Defendant

Dispute Note on behalf of the following parties:

______________

1        I dispute the Plaintiff’s Civil Claim for the following reasons:

2 I Counterclaim or Claim a set‑off for $________________, for the following reasons:

I will be calling __________ witnesses.

o   I abandon that part of my Counterclaim that exceeds the financial jurisdiction of this Court.  I understand and agree that I cannot recover in this Court or in any other court the part of my Counterclaim that is abandoned.

My address for service is:

 

 

 

City

 

Province

 

Postal Code

 

Res. Phone

 

Bus.

Phone

Dated ____________

________________________________

at _______, Alberta        Signature of Defendant/Agent/Solicitor

________________________________

Print Name

See other side (turn over) for important instructions to the Defendant.

FORM 3   (BACK)

Things to Know to Dispute this Civil Claim

If you do not have a legitimate reason for disputing a claim, filing a Dispute Note may result in increased costs to you.

1    In paragraph 1, state clearly the reasons you are disputing the Civil Claim.  If you dispute only part of the Civil Claim, set out which part is disputed.

2    In paragraph 2, if you are claiming an amount from the Plaintiff, clearly set out the amount you are claiming and the reasons.

3    In paragraph 3, set out an address at which documents may be served on you.

4    Deliver the completed Dispute Note in person, by fax machine or by mail to the Court address shown on the front of the Civil Claim, within the time limit set out on the Notice to the Defendant, on the back of your copy of the Civil Claim.  Call the Court office if you need help to count the number of days.

After you have delivered the Dispute Note, you will be notified in writing by the Court of the time, date and place of the appearance.

Please do not send any additional material with the Dispute Note (i.e. books, papers, etc.).

It is your responsibility to notify the Court office of any changes in your address.

AR 55/2001 Sched.;176/2012