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Alberta Regulation 204/2004
Government Organization Act
MUNICIPAL AFFAIRS GRANTS AMENDMENT REGULATION
Filed: September 22, 2004
Made by the Lieutenant Governor in Council (O.C. 430/2004) on September 22, 2004 
pursuant to section 13 of the Government Organization Act. 
1   The Municipal Affairs Grants Regulation (AR 123/2000) is 
amended by this Regulation.

2   Section 1(3) of Schedule 2 is amended by striking out 
"and 2004" and substituting " , 2004 and 2005".


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Alberta Regulation 205/2004
Real Estate Act
EXEMPTION AMENDMENT REGULATION
Filed: September 22, 2004
Made by the Lieutenant Governor in Council (O.C. 436/2004) on September 22, 2004 
pursuant to section 84 of the Real Estate Act. 
1   The Exemption Regulation (AR 111/96) is amended by 
this Regulation.

2   Section 2 is amended
	(a)	in subsection (1) by striking out "exempted" and 
substituting "exempt";
	(b)	by adding the following after subsection (2):
(3)  The following persons are exempt from the Act as it relates 
to acting as a real estate appraiser:
	(a)	a person who appraises a business that has no premises 
or other interests in land;
	(b)	an accredited municipal assessor of Alberta or a 
candidate member as defined in the Municipal Assessor 
Regulation (AR 84/94), when the accredited municipal 
assessor or candidate member is involved in the practice 
of assessment as defined in the Municipal Assessor 
Regulation (AR 84/94).

3   This Regulation comes into force on October 1, 2004.


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Alberta Regulation 206/2004
Youth Criminal Justice Act (Canada) 
Youth Justice Act (Alberta)
YOUTH JUSTICE DESIGNATION AMENDMENT REGULATION
Filed: September 22, 2004
Made by the Lieutenant Governor in Council (O.C. 440/2004) on September 22, 2004 
pursuant to the Youth Criminal Justice Act (Canada) and section 35 of the Youth 
Justice Act (Alberta). 
1   The Youth Justice Designation Regulation (AR 69/2003) 
is amended by this Regulation.

2   Section 4(d) is repealed.

3   Section 5 is amended
	(a)	by repealing clause (b);
	(b)	by repealing clause (c).

4   Section 7 is amended
	(a)	by repealing clause (e);
	(b)	by repealing clause (h);
	(c)	by repealing clause (i);
	(d)	by repealing clause (j).



Alberta Regulation 207/2004
Health Insurance Premiums Act
HEALTH INSURANCE PREMIUMS AMENDMENT REGULATION
Filed: September 22, 2004
Made by the Lieutenant Governor in Council (O.C. 442/2004) on September 22, 2004 
pursuant to section 2 of the Health Insurance Premiums Act. 
1   The Health Insurance Premiums Regulation (AR 217/81) 
is amended by this Regulation.

2   Section 2 is amended by striking out "8.2" and 
substituting "3.1".



3   The following is added after section 3:

3.1(1)  Notwithstanding section 3, if a registrant or the registrant's 
spouse or adult interdependent partner is 65 years of age or over, 
the registrant is eligible for a full premium subsidy on behalf of the 
registrant and the registrant's dependants.
(2)  Where only the registrant's spouse or adult interdependent 
partner is 65 years of age or over, subsection (1) only applies if the 
registrant's spouse or adult interdependent partner is a resident of 
Alberta.
(3)  Sections 7(2) and (3) and 8 do not apply to a subsidy under this 
section.
(4)  This section is effective with respect to a registrant,
	(a)	who becomes a registrant on or after October 1, 2004, 
on the date on which the registration becomes effective, 
where at the time of registration the registrant or the 
registrant's spouse or adult interdependent partner is 65 
years of age or over,
	(b)	on October 1, 2004, where the registrant or the 
registrant's spouse or adult interdependent partner is 65 
years of age or over on that date,
	(c)	on the first day of the first month following the 65th 
birthday of the registrant or the registrant's spouse or 
adult interdependent partner, where the birthday occurs 
after October 1, 2004, or
	(d)	on the 65th birthday of the registrant or the registrant's 
spouse or adult interdependent partner, where the 
birthday falls on the first day of a month and occurs 
after October 1, 2004.
(5)  The subsidy under this section ceases at the end of the 2nd 
month following the month in which the death occurs, as the case 
may be, of the registrant or the registrant's spouse or adult 
interdependent partner who was 65 years of age or over at the 
time of death.

4   Section 8.2 is repealed.

5   This Regulation comes into force on October 1, 2004.


--------------------------------
Alberta Regulation 208/2004
Public Sector Pension Plans Act
LOCAL AUTHORITIES PENSION PLAN (NEW EMPLOYERS, 2004) 
AMENDMENT REGULATION
Filed: September 22, 2004
Made by the Lieutenant Governor in Council (O.C. 445/2004) on September 22, 2004 
pursuant to Schedule 1, section 4 of the Public Sector Pension Plans Act and Schedule 
1, section 2.1 of the Public Sector Pension Plans (Legislative Provisions) Regulation. 
1   The Local Authorities Pension Plan (AR 366/93) is 
amended by this Regulation.

2   Part 1 of Schedule 2 is amended by adding the following 
in their appropriate alphabetical order:

Aquatera Utilities Inc.
The Business Link Business Service Centre
Children's Services Centre, An Alberta Society

3   Section 2,
	(a)	as it applies to The Business Link Business Service 
Centre, is deemed to have come into force on April 
1, 2002;
	(b)	as it applies to Children's Services Centre, An 
Alberta Society, is deemed to have come into force 
on July 1, 2002;
	(c)	as it applies to Aquatera Utilities Inc., is deemed to 
have come into force on January 1, 2003.


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Alberta Regulation 209/2004
School Act
HOME EDUCATION AMENDMENT REGULATION
Filed: September 23, 2004
Made by the Minister of Learning (M.O. 064/2004) on September 21, 2004 pursuant 
to section 29(3) of the School Act. 
1   The Home Education Regulation (AR 126/99) is amended 
by this Regulation.

2   Section 11 is amended by striking out "October 1, 2004" 
and substituting "March 31, 2005".


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Alberta Regulation 210/2004
Mobile Home Sites Tenancies Act
MOBILE HOME SITES TENANCIES MINISTERIAL 
AMENDMENT REGULATION
Filed: September 29, 2004
Made by the Minister of Government Services (M.O. C:004/2004) on September 27, 
2004 pursuant to section 66 of the Mobile Home Sites Tenancies Act. 
1   The Mobile Home Sites Tenancies Ministerial Regulation 
(AR 54/96) is amended by this Regulation.

2   Section 3(1) and (4) to (7) are repealed and the following 
is substituted:
(4)  When an inspection has been conducted by the landlord and 
the tenant or their agents, the inspection report
	(a)	must contain the following statement, and the landlord 
or landlord's agent must sign the statement:
		The inspection of the mobile home site was conducted 
on   (date)   by   (landlord or landlord's agent)   and by 
  (tenant or tenant's agent)  .
			and
	(b)	must contain both of the following statements, and the 
tenant or the tenant's agent must sign one of the 
statements:
	(i)	I,   (name of tenant or tenant's agent)  , agree that 
this report fairly represents the condition of the 
mobile home site.
				or
	(ii)	I,   (name of tenant or tenant's agent)  , disagree 
that this report fairly represents the condition of 
the mobile home site for the following reasons:
(5)  Where the tenant or the tenant's agent refuses to sign one of 
the statements set out in subsection (4)(b), the inspection report 
must contain the following statement, and the landlord or the 
landlord's agent must sign the statement:
		The tenant or tenant's agent present at the inspection refused 
to sign the tenant's statement.
(6)  Where an inspection is conducted by the landlord or the 
landlord's agent without the tenant or the tenant's agent being 
present, the inspection report must contain the following statement, 
and the landlord or landlord's agent must sign the statement:
		The inspection of the mobile home site was conducted on 
  (date)   by   (landlord or landlord's agent)  without the 
tenant or the tenant's agent being present.

3   Section 5(2)(b) and (3)(b) are amended by striking out 
"Superintendent of Real Estate" and substituting "Director of 
Residential Tenancies".

4   Section 7 is repealed and the following is substituted:
Investment of security deposit trust account
7   Money in a security deposit trust account may be invested only 
in deposit receipts, deposit notes, certificates of deposit, bankers 
acceptances, debt securities issued by the Government of Canada 
or Alberta and other similar instruments issued by or guaranteed as 
to principal and interest by a bank, credit union, loan corporation, 
treasury branch, trust corporation or insurance company authorized 
to carry on business in Alberta.

5   Section 8(1) is amended by adding "at the end of the 
tenancy" before "and transferred".

6   Section 12 is amended by striking out "October 31, 2004" 
and substituting "October 31, 2010".

7   The Schedule is repealed and the following is 
substituted:
Schedule 
 
Form 1
This notice may be used by a landlord to terminate a periodic tenancy.
Landlord's Notice to Tenant 
Termination of a Periodic Tenancy
TO:                                     (name of tenant)	 
                        (address, including postal code)	
I give you notice that the periodic tenancy between me as landlord and 
you as tenant for   (identify the mobile home site)   is terminated on 
  (date)  .  You are required to vacate the mobile home site by   (time)   
on that date.  (Section 22 of the Mobile Home Sites Tenancies Act 
states that a tenancy terminates at 12 noon on the last day of the 
tenancy unless the landlord and tenant agree to a different time.)
The tenancy is being terminated for the following reason(s):
	 
	
Dated this                     day of                   , 20    
		   (signature of landlord or landlord's agent) 	 
   (print name of landlord or landlord's agent) 	 
   (address, including postal code) 	 
  ( telephone) 	
Form 2
This notice may be used by a tenant to terminate a periodic tenancy.
Tenant's Notice to Landlord 
Termination of a Periodic Tenancy
TO:                                 (name of landlord)  	
	                      (address, including postal code)  	
I give you notice that the periodic tenancy between me as tenant and 
you as landlord for   (identify the mobile home site)   is terminated on 
  (date)  .  I will give up possession of the mobile home site by 
  (time)   on that date.  (Section 22 of the Mobile Home Sites Tenancies 
Act states that a tenancy terminates at 12 noon on the last day of the 
tenancy unless the landlord and tenant agree to a different time.)
Dated this                    day of                 , 20     
		   (signature of tenant or tenant's agent)	 
   (print name of tenant or tenant's agent)	 
   (address, including postal code)	 
   (telephone)	
Form 3
This notice may be used by a landlord to terminate a tenancy under 
section 32 of the Act when the tenant commits a substantial breach of 
the tenancy agreement.
Landlord's Notice to Tenant 
Termination of Tenancy for Substantial Breach
TO:                                (name of tenant)	  
                 (address, including postal code)  	
I give you notice that the tenancy between me as landlord and you as 
tenant for   (identify the mobile home site)   is terminated on   (date)  .  
You are required to vacate the mobile home site by   (time)   on that 
date.  (Section 22 of the Mobile Home Sites Tenancies Act states that a 
tenancy terminates at 12 noon on the last day of the tenancy unless the 
landlord and tenant agree to a different time.)
The tenancy is being terminated because you have committed the 
following act(s) which constitutes a substantial breach of our tenancy 
agreement:
	 
	
Dated this                    day of                 , 20       
		  (signature of landlord or landlord's agent)  	 
  (print name of landlord or landlord's agent)  	 
  (address, including postal code)  	 
  (telephone)  	
*IMPORTANT:   This notice must be served on the tenant at least 14 
days before the day that the tenancy is to terminate.
Form 4
This notice may be used by a landlord to terminate a tenancy under 
section 33 of the Act when the tenant has
	(a)	done or permitted significant damage to the mobile home 
site, the common areas or the property of which they form a 
part, or
	(b)	physically assaulted the landlord or other tenants.
Landlord's Notice to Tenant 
24-hour Notice of Termination
TO:                                  (name of tenant)	  
	                    (address, including postal code)  	
I give you notice that the tenancy between me as landlord and you as 
tenant for   (identify the mobile home site)   is terminated on   (date)  .  
You are required to vacate the mobile home site by   (time)   on that 
date.
The tenancy is being terminated for the following reason(s):
	 
	
Dated this                    day of               , 20       
		  (signature of landlord or landlord's agent)  	 
  (print name of landlord or landlord's agent)  	 
  (address, including postal code)  	 
  (telephone)  	

8   This Regulation comes into force on November 1, 2004.


--------------------------------
Alberta Regulation 211/2004
Residential Tenancies Act
RESIDENTIAL TENANCIES MINISTERIAL REGULATION
Filed: September 29, 2004
Made by the Minister of Government Services (M.O. C:012/2004) on September 27, 
2004 pursuant to section 70 of the Residential Tenancies Act. 
Table of Contents
	1	Definitions
	2	Termination of periodic tenancies
	3	Rent increases
	4	Inspection reports
	5	Abandoned goods
	6	Establishing tenant's liabilities
	7	Trustee of security deposit trust account
	8	Investment of security deposit trust account
	9	Withdrawals from security deposit trust account
	10	Trustee Act
	11	Offence
	12	Forms
	13	Repeal
	14	Expiry
	15	Coming into force 
 
Schedule
Definitions
1   In this Regulation,
	(a)	"Act" means the Residential Tenancies Act;
	(b)	"non-owner landlord", in respect of residential premises, 
means a person who falls within the definition of landlord in 
the Act, other than an owner of the premises;
	(c)	"security deposit trust account" means a trust account 
referred to in section 44(1)(a) of the Act for security deposits 
consisting of money.
Terminations of periodic tenancies
2(1)  In this section,
	(a)	"major renovations" does not include painting, the 
replacement of a floor covering or routine maintenance;
	(b)	"relative" includes any relative by blood, marriage or 
adoption or by virtue of an adult interdependent relationship.
(2)  For the purposes of section 6(1) of the Act, a landlord may 
terminate a periodic tenancy for any of the following prescribed 
reasons:
	(a)	if the landlord or a relative of the landlord intends to occupy 
the residential premises of the tenant;
	(b)	if the landlord has entered into an agreement to sell the 
residential premises of the tenant in which all conditions 
precedent in the agreement have been satisfied or waived and
	(i)	the purchaser or a relative of the purchaser intends to 
occupy the premises, or
	(ii)	the agreement is to sell one detached or semi-detached 
dwelling unit or one condominium unit,
		and the purchaser requests in writing that the landlord give 
the tenant a notice to terminate the tenancy;
	(c)	if the landlord intends
	(i)	to demolish the building in which the residential 
premises of the tenant are located, or
	(ii)	to make major renovations to the residential premises of 
the tenant that require the premises to be unoccupied;
	(d)	if the landlord intends to use or rent the residential premises 
of the tenant for a non-residential purpose;
	(e)	in a case where the landlord is an educational institution and 
the tenant is a student of that institution, if the tenant is no 
longer a student or will no longer be a student when the 
notice period for terminating the tenancy has passed.
Rent increases
3   For the purposes of section 14(4) of the Act, a landlord shall not 
increase the rent payable under a residential tenancy agreement or 
recover any additional rent resulting from an increase unless,
	(a)	in respect of a weekly tenancy, at least 26 tenancy weeks 
have passed since the last rent increase,
	(b)	in respect of a monthly tenancy, at least 6 tenancy months 
have passed since the last rent increase, or
	(c)	in respect of any other periodic tenancy, at least 180 days 
have passed since the last rent increase.
Inspection reports
4(1)  Each inspection report made under section 19 of the Act must 
contain statements in accordance with this section and the statements 
must be signed in accordance with this section.
(2)  Each inspection report must contain the following statement:
		Inspections should be conducted when the premises are 
vacant unless the landlord and tenant or their agents 
otherwise agree.
(3)  When an inspection has been conducted by the landlord and the 
tenant or their agents, the inspection report
	(a)	must contain the following statement, and the landlord or the 
landlord's agent must sign the statement:
		The inspection of the premises was conducted on   (date)   by 
  (landlord or landlord's agent)   and by   (tenant or tenant's 
agent)  .
		and
	(b)	must contain both of the following statements, and the tenant 
or the tenant's agent must sign one of the statements:
	(i)		I,   (name of tenant or tenant's agent)  , agree that this 
report fairly represents the condition of the premises.
			or
	(ii)	I,   (name of tenant or tenant's agent)  , disagree that this 
report fairly represents the condition of the premises for 
the following reasons:
(4)  Where the tenant or the tenant's agent refuses to sign one of the 
statements set out in subsection (3), the inspection report must contain 
the following statement, and the landlord or the landlord's agent must 
sign the statement:
		The tenant or tenant's agent present at the inspection refused 
to sign the tenant's statement.
(5)  Where an inspection is conducted by the landlord or the landlord's 
agent without the tenant or tenant's agent being present, the inspection 
report must contain the following statement, and the landlord or the 
landlord's agent must sign the statement:
		The inspection of the premises was conducted on   (date)   by 
  (landlord or landlord's agent)  without the tenant or the 
tenant's agent being present.
Abandoned goods
5(1)  The prescribed amount for the purposes of section 31(2) and (3) 
of the Act is $2000.
(2)  The prescribed period for the purposes of section 31(4)(a) of the 
Act is 30 days.
Establishing tenant's liabilities
6(1)  In this section, "tenant" includes a person
	(a)	who was a tenant of premises,
	(b)	whose tenancy has expired or been terminated, and
	(c)	who has vacated the premises.
(2)  A tenant's liability to a landlord for rent is established for the 
purposes of section 31(9) of the Act if the landlord
	(a)	makes an affidavit that sets out the amount of rent owing by 
the tenant, and
	(b)	mails the affidavit to the last known address of the tenant and 
provides a copy of the affidavit to the Director of Residential 
Tenancies appointed under section 55 of the Act.
(3)  A tenant's liability to the landlord for damage to the residential 
premises that have been repaired is established for the purposes of 
section 31(9) of the Act if the landlord
	(a)	makes an affidavit that sets out
	(i)	the damage to the premises,
	(ii)	if the landlord hired someone to repair the damage, the 
cost of the repairs based on receipts attached to the 
affidavit as an exhibit, and
	(iii)	if the landlord made the repairs, the cost of the repairs 
based on receipts for materials attached to the affidavit 
as an exhibit and a reasonable amount for the landlord's 
labour,
		and
	(b)	mails the affidavit to the last known address of the tenant and 
provides a copy of the affidavit to the Director of Residential 
Tenancies appointed under section 55 of the Act.
(4)  In addition to the methods for establishing a tenant's liability 
under subsections (2) and (3), any liability of the tenant to a landlord in 
respect of a tenancy is established for the purposes of section 31(9) of 
the Act if the landlord obtains a judgment against the tenant.
Trustee of security deposit trust account
7(1)  If a residential tenancy agreement is between a non-owner 
landlord and a tenant, the non-owner landlord is the sole trustee of the 
money paid by the tenant as a security deposit that is held in a security 
deposit trust account.
(2)  A non-owner landlord of residential premises who, under 
subsection (1), is the sole trustee of the money in a security deposit 
trust account shall hold and administer the trust account until the 
non-owner landlord ceases to be a landlord of those premises.
(3)  The owner of residential premises shall not hold and administer a 
security deposit trust account in respect of those premises if a 
non-owner landlord of those premises is required under subsection (2) 
to hold and administer the security deposit trust account.
Investment of security deposit trust account
8   Money in a security deposit trust account may be invested only in 
deposit receipts, deposit notes, certificates of deposit, bankers 
acceptances, debt securities issued by the Government of Canada or 
Alberta and other similar instruments issued by or guaranteed as to 
principal and interest by a bank, credit union, loan corporation, 
treasury branch, trust corporation or insurance company authorized to 
carry on business in Alberta.
Withdrawals from security deposit trust account
9(1)  If a landlord is entitled under the Act to the money in a security 
deposit trust account, the money may be withdrawn from the trust 
account at the end of the tenancy and transferred to the landlord.
(2)  Money that has been withdrawn from the security deposit trust 
account by a non-owner landlord for the purpose of transferring it to 
the landlord who is entitled to the money is subject to the terms of any 
agreement or trust respecting that money between the non-owner 
landlord and the landlord entitled to the money.
Trustee Act
10   Sections 3 to 9, 14, 15, 34 and 35 of the Trustee Act do not apply 
to the trustee of a security deposit trust account.
Offence
11   The contravention of section 2, 3, 4, 5, 6, 7, 8 or 9 of this 
Regulation constitutes an offence for the purposes of section 70(l) of 
the Act.
Forms
12   The forms in the Schedule may be used by landlords and tenants.
Repeal
13   The Residential Tenancies Ministerial Regulation (AR 229/92) is 
repealed.
Expiry
14   For the purpose of ensuring that this Regulation is reviewed for 
ongoing relevancy and necessity, with the option that it may be 
repassed in its present or an amended form following a review, this 
Regulation expires on July 31, 2014.
Coming into force
15   This Regulation comes into force on November 1, 2004.
Schedule
Form 1
This notice may be used by a landlord to terminate a periodic tenancy.
Landlord's Notice to Tenant 
Termination of a Periodic Tenancy
TO:                           (name of tenant)	
                     (address, including postal code)	
I give you notice that the periodic tenancy between me as landlord and 
you as tenant for   (identify the premises)   is terminated on   (date)  .  
You are required to vacate the premises by   (time)   on that date.  
(Section 20 of the Residential Tenancies Act states that a tenancy 
terminates at 12 noon on the last day of the tenancy unless the landlord 
and tenant agree to a different time.)
The tenancy is being terminated for the following reason(s):
		 
	
Dated this          day of                , 20    .
   (signature of landlord or landlord's agent)	 
   (print name of landlord or landlord's agent)	 
   (address, including postal code)	 
   (telephone)	
Form 2
This notice may be used by a tenant to terminate a periodic tenancy.
Tenant's Notice to Landlord 
Termination of a Periodic Tenancy
TO:                                   (name of landlord)	 
                             (address, including postal code)	
I give you notice that the periodic tenancy between me as tenant and 
you as landlord for   (identify the premises)   is terminated on   (date)  .  
I will give up possession of the premises by   (time)   on that date.  
(Section 20 of the Residential Tenancies Act states that a tenancy 
terminates at 12 noon on the last day of the tenancy unless the landlord 
and tenant agree to a different time.)
Dated this          day of                , 20    .
   (signature of tenant or tenant's agent)	 
   (print name of tenant or tenant's agent)	 
   (address, including postal code)	 
   (telephone)	
Form 3
This notice may be used by a landlord to terminate a tenancy under 
section 29 of the Act when the tenant commits a substantial breach of 
the tenancy agreement.
Landlord's Notice to Tenant 
Termination of Tenancy for Substantial Breach
TO:                                (name of tenant)	
                        (address, including postal code)	
I give you notice that the tenancy between me as landlord and you as 
tenant for   (identify the premises)   is terminated on   (date)  .  You are 
required to vacate the premises by   (time)   on that date.  (Section 20 
of the Residential Tenancies Act states that a tenancy terminates at 12 
noon on the last day of the tenancy unless the landlord and tenant agree 
to a different time.)
The tenancy is being terminated because you have committed the 
following act(s) which constitutes a substantial breach of our 
residential tenancy agreement:
		 
	
Dated this          day of                , 20    .
   (signature of landlord or landlord's agent)	 
   (print name of landlord or landlord's agent)	 
   (address, including postal code)	 
   (telephone)	

?	This notice must be served on the tenant at least 14 days before 
the day that the tenancy is to terminate.

?	If this notice is for the non-payment of rent, the tenancy will not 
be terminated if, on or before the termination date specified in 
this notice, the tenant pays the rent due and any additional rent 
that has become due under the residential tenancy agreement as 
of the date of payment.
Form 4
This notice may be used by a landlord to terminate a tenancy under 
section 30 of the Act when the tenant has
	(a)	done or permitted significant damage to the residential 
premises, the common areas or the property of which they 
form a part, or
	(b)	physically assaulted or threatened to physically assault the 
landlord or another tenant.
Landlord's Notice to Tenant 
24-hour Notice of Termination of Tenancy
TO:                             (name of tenant)	
                     (address, including postal code)	
I give you notice that the tenancy between me as landlord and you as 
tenant for   (identify the premises)   is terminated on   (date)  .  You are 
required to vacate the premises by   (time)   on that date.
The tenancy is being terminated for the following reason(s):
		 
	
Dated this          day of                , 20    .
   (signature of landlord or landlord's agent)	 
   (print name of landlord or landlord's agent)	 
   (address, including postal code)	 
   (telephone)	
Form 5
This notice may be used by a landlord to require a person who is not a 
tenant but who is living in residential premises to vacate those 
premises when
	(a)	the tenant has abandoned the premises, pursuant to section 33 
of the Act, or
	(b)	the premises are occupied by a tenant, pursuant to section 36 
of the Act.
Landlord's Notice to Vacate 
to Person(s) who are Not Tenants
TO:                    (name of person(s) required to vacate)	
                                (address, including postal code)	
I give you notice that you are required to vacate   (identify the 
premises)   on   (date)   by   (time)  .  You are required to vacate for the 
following reason:
		 
	
Dated this          day of                , 20    .
   (signature of landlord or landlord's agent)	 
   (print name of landlord or landlord's agent)	 
   (address, including postal code)	 
   (telephone)	
Form 6
This notice may be used by a tenant to terminate a tenancy under 
section 28 of the Act when the landlord commits a substantial breach 
of the tenancy agreement and the specified conditions under section 28 
have been met.
Tenant's Notice to Landlord 
Termination of Tenancy for Substantial Breach
TO:                             (name of landlord)	
                         (address, including postal code)	
I give you notice that the tenancy between me as tenant and you as 
landlord for   (identify the premises)   is terminated on   (date)  .  I will 
vacate the premises by   (time)   on that date.  (Section 20 of the 
Residential Tenancies Act states that a tenancy terminates at 12 noon 
on the last day of the tenancy unless the landlord and tenant agree to a 
different time.)
The tenancy is being terminated because you have committed the 
following substantial breach:
		
		
Dated this          day of                , 20    .
   (signature of tenant or tenant's agent)	
   (print name of tenant or tenant's agent)	
   (address, including postal code)	
   (telephone)	

?	This notice must be served on the landlord at least 14 days 
before the day that the tenancy is to terminate.



Alberta Regulation 212/2004
Persons with Developmental Disabilities Community Governance Act
GOVERNANCE (MINISTERIAL) REGULATION
Filed: September 29, 2004
Made by the Minister of Community Development (M.O. 45/04) on September 27, 
2004 pursuant to section 23(2) of the Persons with Developmental Disabilities 
Community Governance Act. 
Appeal form
1   The form of a notice of appeal to the Provincial Board is in the 
attached Form 1.
Repeal
2   The Governance (Ministerial) Regulation (AR 195/97) is repealed.
Expiry
3   For the purpose of ensuring that this Regulation is reviewed for 
ongoing relevancy and necessity, with the option that it may be 
repassed in its present or an amended form following a review, this 
Regulation expires on October 1, 2010.


Form 1 
 
Notice of Appeal to the Provincial Board
1	My name is                               (name)	
	My address is                          (address)	
	My telephone number is            (telephone number)	
2	I am (check one):	     	a person who has been affected by a 
decision of a Community Board.
			     	the guardian of   (name of 
dependent adult)  , who is a person 
who has been affected by a decision 
of a Community Board.
			     	the agent of   (name of maker of 
personal directive)  , who is a 
person who has been affected by a 
decision of a Community Board.
3	I am appealing a decision of               (name of Board)	
	The decision I am appealing is 	
	I was told about the decision on         (year/month/day)	
	My reasons for appealing the decision are:  	
			
4	I understand that before proceeding with a formal hearing of my 
appeal this dispute can be referred to an impartial person who will 
attempt to mediate the dispute.
	     	I agree to having my appeal referred to a mediator
	     	I do not agree to having my appeal referred to a mediator
     (year/month/day)     
     (signature of person appealing)     


--------------------------------
Alberta Regulation 213/2004
Election Act
ELECTION ACT FORMS REGULATION
Filed: September 29, 2004
Made by the Lieutenant Governor in Council (O.C. 450/2004) on September 29, 2004 
pursuant to section 207 of the Election Act. 
1   The Forms in the attached Schedule are the forms prescribed under 
the Election Act.

2   The Election Forms Regulation (AR 369/92) is repealed.


Schedule 
 
Form 1

Province of Alberta	Election Act 
	(Section 39)    
 
Writ of Election
        Canada 
Province of Alberta
Elizabeth The Second, by the Grace of God, of the United 
Kingdom, Canada and her other Realms and Territories, Queen, 
Head of the Commonwealth, Defender of the Faith.
To                   , of                              in the Province of Alberta.
Greeting:


We command you that, notice of the time and place of election 
being given, you do cause an election to be held according to law, 
to elect a Member to serve in the Legislative Assembly of Our 
Province of Alberta for the Electoral Division of         with 
nomination day for the election to be the     day of        next, and 
that in the event of a poll being required you do cause a poll to be 
taken on the      day of        , 20   , and you do certify the name of 
the member, so elected to the Chief Electoral Officer on the      day 
of         , 20     next, being the date fixed for the return of the writ.
Dated at the City of Edmonton in the Province of Alberta, this 
           day of             , 20     .
Endorsement                      
By Order:                                      The writ received on the 
     Chief Electoral Officer                     day of       , 20     
                                                                                                        
                                                                 Returning Officer
Form 2 

Chief Electoral Officer	Election Act                        
        Alberta	(Section 55)                        
 
Election Proclamation
ELECTORAL DIVISION                                                        
For the purpose of electing a representative to the Legislative 
Assembly of Alberta for the Electoral Division of                    
Public Notice is hereby given to the electors that the following are 
fixed pursuant to the Election Act.
REVISIONS TO LIST OF ELECTORS 
AT:                               (Address)                                       
FROM:    (Day/Month)    TO:    (Day/Month)    20                to        
on weekdays, and              to             on Saturdays, excluding holidays. 
Revisions close at 4:00 P.M. on Saturday             (Date)              
NOMINATION OF CANDIDATES 
COMMENCING immediately and continuing until 2:00 P.M. on  
     (Calendar Day)         (Day/Month/Year)   , excluding Sundays and 
holidays, nomination papers may be filed with the Returning Officer.
ADVANCE POLLS               9:00 A.M. TO 8:00 P.M. 
THURSDAY                      (Date)                   
FRIDAY                             (Date)                   
SATURDAY                      (Date)                   
AT       (Address(es) where advance poll(s) will be held)       
POLLING DAY                      9:00 A.M. TO 8:00 P.M. 
     (Calendar Day)                         (Day/Month/Year)   
ANNOUNCEMENT OF OFFICIAL RESULTS 
                           (Place, Time, and Date)                                 
Additional information concerning the Election may be obtained 
from the Returning Officer at 
   (Address of Returning Officer)           (Telephone Number)    
ISSUED        (Date)        BY           (Returning Officer)        
GOD SAVE THE QUEEN
Form 3
Chief Electoral Officer               	Election Act 
           Alberta             	(Sections 9,28,47,47.1, 
	71,73,76,77.1,78)
 
Appointment and Oath of Election Officer
I,             (Name)            of          (Address)               appointed as  
     (Capacity of Election Officer)      in    (Electoral Division)      
Polling Subdivision number     (Complete if applicable)   , in the 
Province of Alberta, which duties I will perform in accordance with 
the provisions of the Election Act, Swear (or solemnly Affirm) that I 
am legally qualified to act as    (Capacity of Election Officer)   and that 
I will act faithfully without partiality, fear, favour, or affection.
SO HELP ME GOD 
(Omit if Affirmed)
SWORN (or Affirmed) BEFORE ME	) 
 at the                 of               , in the 	) 
Province of Alberta, this         day 	) 	                  (Signature)          
of                        ,             	 .) 
	) 
 (Signature of Returning Officer, Election Clerk	) 
 Deputy Returning Officer, Commissioner 	) 
 for Oaths, Justice of the Peace or Notary Public)	)
Other Information
Social Insurance Number: 	 
Telephone Number: 	 
Enumerator's Identification Number: 	 
Serial Numbers of Enumeration Records: 	 
Serial Number of Ballot Box Seal: 	
RETURNING OFFICER COPY
Form 4
Chief Electoral Officer       	Election Act
              Alberta                      	 (Sections 56 - 61)
 
Candidate Nomination Paper
We, the undersigned electors, resident in the Electoral Division of 
   (Name of Electoral Division)   , nominate         (Candidate)      , 
representing    (Registered Political Party or Independent)   , as a 
Candidate for the election now being held.

Printed Name 
of Elector
Address in
Electoral Division
Signature of Elector
1


2


3


I,    (Print Name)   , Swear (or Affirm) that I witnessed the signatures 
of the electors recorded on this Candidate Nomination Paper.
SWORN (or Affirmed) BEFORE ME	) 
 at the                 of               , in the 	) 
Province of Alberta, this         day 	) 	 (Signature of Attesting Witness)   
of                        ,             	 .) 
	) 
 (Signature of Returning Officer,	) 
Commissioner for Oaths or Notary Public)	)
Prior to the nomination being accepted, the candidate must be 
registered under the Election Finances and Contributions Disclosure 
Act.
Form 5
Chief Electoral Officer               	Election Act  
           Alberta             	(Sections 56-62) 
 
Declaration of Candidate and 
Appointment of Official Agent
I,    (Print Name of Candidate)   , declare that I am eligible under 
section 56 of the Election Act to be a candidate, that I consent to my 
nomination and wish my name to appear on the ballot paper as    (Print 
Any Combination of Given Names, Initials or Nickname)           
                                        (Print Surname)	. 
In accordance with section 60 of the Election Act, I appoint   (Print  
Name)         of                  (Address)                   as my official agent.

Complete A or B
I understand that prior to my nomination being accepted, I must be 
registered under the Election Finances and Contributions Disclosure 
Act.
	A.	The attached certificate from   (Registered Political Party)   
confirms my endorsement as the official candidate in the 
Electoral Division of    (Electoral Division)      
     (Date)         	         (Signature of Candidate)   
OR
	B.	I am an independent candidate in the Electoral Division of  
      (Electoral Division)       
     (Date)         	         (Signature of Candidate)   
Consent of Official Agent
I,   (Print Name)  , consent to my appointment as the official agent. 
Documents may be served and notices given respecting the candidate 
at:    (Complete Address including Postal Code)       (Business 
Telephone Number)     (Home Telephone Number) (Fax Number)             
(Date)        (Signature of official agent)              
Receipt for Deposit and 
Filing of Nomination Paper
Received, on behalf of    (Name of Candidate)   , the sum of $500.00 
and the Candidate Nomination Paper pursuant to section 61 of the 
Election Act. 
       (Date)         	         (Signature of Returning Officer)   
Form 6
Chief Electoral Officer	Election Act
              Alberta                                    	(Section 61)
 
Candidate's Nomination Endorsement Certificate
I certify that                         (Nominee)	 
is the Candidate officially endorsed by the: 
         (Name of Registered Political Party)	 
for the Electoral Division of: 	
                (Date)                	      (Signature of authorized representative of 
                                                                            the Registered Political Party)         
Form 7
Chief Electoral Officer  	Election Act 
           Alberta     	 (Sections 79,92)
 
Appointment of Scrutineer
Electoral Division 	
I, hereby appoint      (Print Name of Scrutineer)     of     (Complete 
Address)    as a scrutineer for   (Print Name of Candidate)   at polling 
station number(s)                   and/or registration officer station location 
                     
            (Date)                (Signature of Candidate or Official Agent)  
Form 8 

Chief Electoral Officer    	Election Act                          
           Alberta     	(Section 64)                          
 
Election Acclamation
I hereby certify that the member elected for the Electoral Division of  
                                                                                                  
in pursuance of the Writ of Election is
                                           (Name)	
                               (Political Affiliation)	
No other candidates having been nominated
or
the other candidate(s) having withdrawn.
              (Date)                      (Signature of Returning Officer)    

Form 9
Chief Electoral Officer  	Election Act  
           Alberta     	 (Section 67) 
 
Official Agents of Nominated Candidates
ELECTORAL DIVISION           (Name of Electoral Division)       

Candidate 
Political Affiliation

Official Agent 
Telephone Number

Campaign 
Address

























   (Print Returning Officer's Name)   
Form 10
Chief Electoral Officer  	Election Act 
           Alberta     	 (Section 69)
 
Notice of Poll Being Granted 
and Candidates Nominated
ELECTORAL DIVISION 	
PUBLIC NOTICE is hereby given to the electors of the aforesaid Electoral 
Division that a poll has been demanded at the election now pending for the 
said Electoral Division and that I have granted such poll; and further that 
the persons duly nominated as candidates at the said election and for 
whom votes will be received are
NAME	POLITICAL AFFILIATION       
                                                                                                                       
                                                                                                                       
                                                                                                                       
              (Date)                                         (Signature of Returning Officer)   
Form 11
Chief Electoral Officer                     	Election Act
          Alberta                                 	(Section 78)
 
Oath of Interpreter
I,     (Print Name)      , swear (or affirm) that I will, to the best of my 
skill and judgment, after my appointment as interpreter, make a true 
   (language)     interpretation of all voting instructions and that I will 
in the English language repeat the person's questions and statements to 
the election officers.
SWORN (or Affirmed) BEFORE ME	) 
 at the                 of               , in the 	) 
Province of Alberta, this         day 	) 	              (Signature of          
of                        ,             	 .)	     Person Taking Oath)      
	) 
 (Signature of Returning Officer, Election Clerk	) 
 Deputy Returning Officer, Commissioner 	) 
 for Oaths, Justice of the Peace or Notary Public)	)
Form 12
Chief Electoral Officer            	Election Act
           Alberta                        	(Section 82)
 
Affidavit of Printer
ELECTORAL DIVISION 	
I,     (print name)      SWEAR (or Affirm):
That by direction of the Returning Officer for the above named 
Electoral Division I printed the ballots for use at the election to be held 
on the             day of                        , 20     on the paper furnished for 
that purpose.
That the attached sample shows the description of the ballots printed 
by me.
That I supplied the Returning Officer with                  of such ballots.
That no other of such ballots were printed by or supplied by me to 
anyone.
SWORN (or Affirmed) BEFORE ME	) 
 at the                 of               , in the 	) 
Province of Alberta, this         day 	) 	       (Signature of Printer)     
of                        ,             	 .) 
	) 
 (Returning Officer, Election Clerk,	)  
Commissioner for Oaths or Notary Public)	)
Form 13
(Ballot front) 


 



 



 



 

 

Form 14
(Ballot back) 

Serial No.                
Number 
from 
Poll Book            

INITIALS OF 
     D.R.O. 
                    
Electoral Division 
of 
                           
 
Year                

(SECOND FOLD)
Printed by                                         

(FIRST FOLD)

Form 15
Chief Electoral Officer            	Election Act  
         Alberta                        	(Section 90)  
 
Notice as to Secrecy of Voting
It is the sworn duty of every person in attendance at this polling place, 
or at the counting of the votes not to attempt to ascertain how any 
person is about to vote or has voted and not to communicate any 
information obtained at the polling place that may enable or assist any 
person to ascertain how any person has voted.
It is further the sworn duty of every such person by all proper means to 
maintain and aid in maintaining the absolute secrecy of the polling at 
this polling place.
By the Election Act, it is further provided that no person shall destroy, 
take, open or otherwise interfere with any ballot box or book or packet 
of ballot papers or a ballot paper or ballot in use for the purpose of the 
election nor shall attempt to do so and any Returning Officer, Deputy 
Returning Officer or other officer engaged in the election who is guilty 
of any violation of that provision is liable to conviction.
Any person who acts in contravention of their duty in any of the said 
particulars is liable to a penalty in accordance with the Election Act.
Form 16
Chief Electoral Officer            	Election Act  
         Alberta                        	(Section 90)  
 
Directions for Guidance of Voters
THE VOTER MUST vote for only one candidate by the use of the "X" 
mark opposite the name of the candidate of the voter's choice in the 
white circle provided.
THE VOTER IS to refold the ballot and return it to the Deputy 
Returning Officer for removal of the counterfoil and placement of the 
ballot in the ballot box.
IF THE VOTER SPOILS a ballot, the voter may return it to the 
Deputy Returning Officer who will give the voter another ballot.

Candidate

MARK ONE CIRCLE ONLY

A ballot marked in more than one circle will not be counted. 
A ballot spoiled or marked in error may be exchanged for another.
Form 17
Chief Electoral Officer                     	Election Act
          Alberta                                 	(Section 90)
 
Offences, Corrupt Practices and 
Voter Disqualification
Offences
Note:	Sections 154(1), 157(2) and (3) and 162(1) of the 
Election Act must be set out here.
Corrupt Practices
Note:	Sections 164, 166, 167, 171, 172, 173, 174, 175 and 
177(1) of the Election Act must be set out here.
Voter Disqualification
Note:	Section 45(a), (b) and (c) of the Election Act must be set 
out here.
NOTE:	The above extracts from the Election Act are provided for 
information of voters, but for a complete enunciation of 
the law relating to offences, corrupt practices and voter 
disqualification reference should be made to the Election 
Act, Chapter E-1 of the Revised Statutes of Alberta 2000.
 Form 18
Chief Electoral Officer                     	Election Act
          Alberta                                 	(Section 93)
 
Oath of Secrecy
Electoral Division               Polling Subdivision Number             
I,     (Print Name)      , swear (or affirm):
?	that I will not attempt to discover and will, by every means in my 
power, prevent any other person from finding out how any person 
is about to vote, or has voted at this election, except as may be 
necessary and proper in the case of persons unable to read or 
incapable of marking their ballots as provided in the Election Act,
?	that I will not communicate to any person any information of any 
kind that may enable or assist any person to ascertain the candidate 
for whom any person has voted, and
?	that I will, in all respects, maintain and aid in maintaining the 
absolute secrecy of the voting at this polling place and at this 
election.
SWORN (or Affirmed) BEFORE ME	) 
 at the                 of               , in the 	) 
Province of Alberta, this         day 	) 	              (Signature of          
of                        ,             	 .)	     Person Taking Oath)      
	) 
(Signature of Returning Officer, Election	) 
Clerk, Registration Officer, Deputy Returning 	) 
Officer, Commissioner  for Oaths, Justice of 	) 
the Peace or Notary Public)	)
Form 19
Chief Electoral Officer                     	Election Act
          Alberta                                 	(Sections 95,104)
 
Oath of Elector
I,    (first name)     (middle initial)     (surname)    of    (residential or 
mailing address)   ,    (city/town/village)   ,    (postal code)    swear (or 
affirm) that I have not previously voted at this election and that I am a 
qualified elector by virtue of being:
?	a Canadian Citizen,
?	18 years of age or older,
?	ordinarily resident of the Province of Alberta for at least the 
immediately preceding 6 months, and
?	ordinarily resident in the polling subdivision in which I wish to 
vote.
?  Check if electors previously registered at this address are to be 
deleted.
SWORN (or Affirmed) BEFORE ME	) 
 at the                 of               , in the 	) 
Province of Alberta, this         day 	) 	  (Signature of Elector) -  
of                        , 20          .	) 	  must be provided prior  
                                                                   	)	  to ballot being issued)        
(Registration Officer, Deputy Returning Officer)	)	   (PSD#)    
Nature of Identification
Two pieces of identification required:	Other identification (be specific):
?	Alberta motor vehicle operator's	Type                                           
	licence number:                         	Number                                      
?	Alberta health insurance card	Type                                           
	number:                                     	Number                                      
?	Senior Citizen's Identification	Type                                           
	Card number:                            	Number                                      

The following information is optional.  If provided, it will be used to 
update the Register of Electors in accordance with the Election Act and 
to create future Lists of Electors.  Date of birth and gender 
information, if provided, will not appear on the List of Electors.
Previous address:     (address)    (city/town/village)       (postal code)    
Date of birth:     (year/month/day)                         Gender:     (m/f)      
Phone number:  (     )                      
Other Electors that moved from this address:                                            
Information collected for the Register of Electors may be shared with other 
electoral agencies to prepare for municipal and federal elections.

 
Directions for exclusion from the Register are on the reverse side 

Form 20
Oath of Elector (back)
I wish to be excluded from the Register of Electors.  I understand that 
my name will not appear on future provincial Lists of Electors, and 
that I will be required to have my name added during the Revision 
Period or by swearing in on Polling Day.
                  (Signature)                                               (Date)              
Form 21
Chief Electoral Officer	Election Act
           Alberta                               	(Section 96)
 
Blind Voter Template
This template is for the use of blind voters who wish to mark their own 
ballot.
?     Detach the ballot from the book,
    -  Place it in the template,
    -  Ensure that the bottom of the ballot is uniform with the bottom of 
the template,
    -  Ensure that the white circles on the ballot are clearly shown 
through the holes of the template
?    Reading from the bottom of the ballot, inform the elector of the 
order of the candidate's name and political affiliation.
 ?    Direct the elector to:
	   -  mark the ballot,
	   -  refold it leaving the perforated counterfoil exposed, and
	   -  return the ballot to the deputy returning officer.
Form 22
Chief Electoral Officer	Election Act
           Alberta                               	(Section 96)
 
Oath of Inability to Read the Ballot or 
 Physical Incapacity
I,    (print name)   , swear (or affirm) that I am unable to read the 
ballot, or that due to physical incapacity I am unable to mark the 
ballot.
SWORN (or Affirmed) BEFORE ME	) 
 at the                 of               , in the 	) 
Province of Alberta, this         day 	) 	       (Identification Mark)      
of                        , 20        .	) 
having first read to the above	) 
named and signed by him in my	) 
presence with his mark.	) 
	) 
 (Signature of  Deputy Returning Officer)	)
Form 23
Chief Electoral Officer	Election Act
           Alberta                               	(Section 96)
 
Oath of Friend of Voter
I,    (Print Name)    of    (Address in Full)    swear (or affirm) that I will 
keep secret for whom I voted on behalf of    (Print Name of Voter)   .
SWORN (or Affirmed) BEFORE ME	) 
 at the                 of               , in the 	) 
Province of Alberta, this         day 	) 	       Signature of Friend      
of                        , 20         .	)	           of Voter)      
	) 
 (Signature of  Deputy Returning Officer)	)
Form 24
Chief Electoral Officer               	Election Act 
           Alberta             	(Section 99)
 
Advance Poll Declaration
Electoral Division                          Advance Poll Number 	
I,   (Print First Name, Middle Initial and Surname of Elector)   of  
   (Residential or Mailing Address)           (City/Town/Village)    ,  
  (Postal Code)   declare that I have not previously voted at this 
election and that I am qualified to vote at the Advance Poll because:
Check	?     I am disabled.
	?     I believe that I will be absent from my ordinary 
place of residence on polling day.
	?     I am an election officer.
	?     I am a candidate, official agent or scrutineer.
	?     I believe that I will be unable to vote on polling 
day.
                         (Date)                   	          (Signature of Elector)     
   (Elector's Polling Subdivision Number    	  (Signature of Deputy Returning Officer)   
Form 25
Special Ballot (front)

Print the name of the candidate OR the registered political 
party of the candidate on the line below.



I vote for:
                                                                                         


Form 26
Special Ballot (back)
 
Special Ballot
Supplied by the Chief Electoral 
Officer

Initials of returning officer, 
election clerk  
or administrative assistant 
                          
                                                       
                
Serial No.
Form 27
Chief Electoral Officer               	Election Act 
           Alberta             	(Section 116)
 
Special Ballot Certificate Envelope
Electoral Division                   Polling Subdivision Number 		
Number from Poll Book                
       (Print First Name, Middle Initial and Surname of Elector)		
   (Address of Ordinary Residence, including Postal Code, within 
Electoral Division)	
Part I
To be completed by Elector
I certify that I am a qualified elector by virtue of being:
?	a Canadian citizen,
?	18 years of age or older,
?	ordinarily resident of the Province of Alberta for at least the 
immediately preceding 6 months, and
?	ordinarily resident in the polling subdivision in which I wish to 
vote.
I certify that I am qualified to vote under Election Act because I am unable 
to attend in person on polling day or at the advance poll by reason of 
being:
(Check one)
?	Physically incapacitated
?	Absent from the Electoral Division
?	An inmate sentenced to a term of 10 days or less, or for the 
non-payment of a fine
?	An Election Officer
?	A Candidate, Official Agent or Scrutineer
?	A resident of a Remote Area
?	Other (specified by Chief Electoral Officer)            
I declare that the above statements are true and that I have not previously 
voted at this election.
Dated at    (Address, including Postal Code, where Special Ballot 
Certificate Envelope is received)    this           day of              , 20    
	        (Signature of Elector)        
Part II
To be completed by the Returning Officer, Election 
Clerk or Administrative Assistant
CHECK:
?	Name of individual recorded on the front of envelope is on the List 
of Electors for the electoral division and polling subdivision
?	Name of individual recorded on the front of envelope is recorded in 
the Special Ballot Poll Book
?	Part I is properly completed
?	Special Ballot Certificate Envelope IS accepted
OR
Special Ballot Certificate Envelope IS NOT opened because:
?	Part I is not properly completed,
?	Received after the close of polls on polling day, or
?	Other (specify)                                                                 
     (Date)     	   (Signature of Returning Officer, Election 
	          Clerk or Administrative Assistant)   
Form 28
Chief Electoral Officer                          	Election Act
          Alberta                                      	(Sections 111,112,118)
 
Statement of Poll
Electoral Division 	(Name of Electoral Division)              
Polling Station Number            Location 	

Number of Ballots Received from Returning Officer    1         
        Number of Ballots Counted for Each Candidate
            Candidate                                 Number of Votes            (RO Use Only)
                             
              

                             
              

                                            Sub Total             2  

                                     Number of Spoiled Ballots            3   
(Ballots spoiled by electors and returned to DRO)              

                                   Number of Declined Ballots            4  
(Ballots returned to the DRO by electors who 
 declined to vote)  

                                   Number of Ballots Not Used            5  
(Unused ballots returned to RO)              

                                      Number of Rejected Ballots          6   
(Ballots deposited in ballot box but not counted as valid) 

     Number of Ballots Removed from Polling Place          7    

                                                                  Total                8  
                                    (Sum of 2, 3, 4, 5, 6, 7)  
 
                                         
 
                                                                       To balance, Line 8 equals Line 1
Total number of names on the List of Electors including those sworn in:            
Number of voters recorded in the Poll Book as having voted:          
   (Signature of Poll Clerk)         (Signature of Deputy Returning Officer)       (Date)  
Form 29
Chief Electoral Officer                          	Election Act
          Alberta                                      	(Section 112)
 
Poll Clerk's Oath After 
Closing the Poll
I,     (Print Name)   , poll clerk for polling station number         located 
at              in the Electoral Division of           , swear (or affirm) that the 
Poll Book for the poll kept under the direction of    (Print DRO 
Name)   , who acted as Deputy Returning Officer:
	?	 was kept correctly by me to the best of my skill and 
judgment, and
	?		the total number of ballots cast according to the Poll Book is        
and that to the best of my knowledge and belief it contains a 
true and exact record of the voters who voted at this polling 
station.
SWORN (or Affirmed) BEFORE ME	) 
 at the                 of               , in the 	) 
Province of Alberta, this         day 	) 	 (Signature of Poll Clerk)   
of                        ,             .	) 
	) 
     (Deputy Returning Officer)       	)
Form 30
Chief Electoral Officer               	Election Act 
           Alberta             	(Section 112)
 
Deputy Returning Officer's Oath  
After Closing the Poll
I,    (Print Name)   , deputy returning officer for polling station number 
      located at                  in the Electoral Division of             , swear (or 
affirm) that to the best of my knowledge and belief:
	?	the Poll Book kept for the poll under my direction has been 
kept correctly,
	?	the total number of ballots cast according to the Poll Book is 
             and it contains a true and exact record of the votes 
given at the poll, and
	?	the Statement of Poll, List of Electors, Poll Book, envelopes 
containing ballots and other documents required to be 
returned by me to the returning officer have been placed in 
the ballot box.
SWORN (or Affirmed) BEFORE ME	) 
 at the                 of               , in the 	) 
Province of Alberta, this         day 	) 	      (Signature of Deputy   
of                        , 20         .	)	       Returning Officer)      
	) 
 (Returning Officer, Election Clerk, Supervisory	) 
 Deputy Returning Officer, Registration Officer,	) 
 Commissioner for Oaths or Notary Public)	)
Form 31
Chief Electoral Officer               	Election Act 
           Alberta             	(Section 137)
 
Returning Officer's Certificate and Return
I hereby certify that at the election held on the         day of             , 20     , 
the following candidates received the number of votes set opposite their 
names:



NAME OF 
CANDIDATE
VOTES 
RECEIVED
POLITICAL 
AFFILIATION









I CERTIFY THAT THE MEMBER ELECTED TO REPRESENT THE 
ELECTORAL DIVISION OF                                                         IS:
NAME
POLITICAL AFFILIATION


Dated at    (City, Town, Village)  , Alberta
             (Date)                 	   (Signature of Returning Officer)   




Form 32
Chief Electoral Officer				Election Act
        Alberta	(Section 137)
 
Statement of Official Results
		Page __ of __
Respecting votes polled and ballots used at the polls for the electoral division of                                            
at the election held on the                day of                           ,               
Poll
Number
Name of 
Poll

Name, political affiliation and number of votes polled for EACH 
candidate in the order that they appeared on the ballot
Nu
mbe
r of 
Vali
d 
Ball
ots  
(Tota
l 
Colu
mns 
A  - 
L)
Number 
of 
Spoiled 
Ballots
(Ballots 
spoiled by 
electors 
and 
returned to 
DRO)
Numb
er of 
Declin
ed 
Ballot
s 
(Ballots 
returned 
to DRO 
by 
electors 
who 
declined 
to vote)
Nu
mbe
r of 
Ball
ots 
Not 
Use
d
(Unu
sed 
ballot
s 
retur
ned 
to 
RO)
Numb
er of 
Reject
ed 
Ballot
s
(Ballots 
deposite
d in 
ballot 
box but 
not 
counted 
as valid)
Nu
mbe
r of 
Ball
ots 
Re
mov
ed 
fro
m 
Poll
ing 
Plac
e
Numb
er of 
Ballots 
Sent to  
Each 
Poll
(Total 
of 
Column
s  2, 3, 
4, 5, 6 
& 7


Total Number of 
Names on 
List of Electors 
(including those 
sworn in at 
advance & 
polling day)





















1
A
B
C
D
E
F
G
H
I
J
K
L
2
3
4
5
6
7
8


































































               Subtotal/Total




























Certified Correct 
          (Signature of Returning Officer)



Form 33
Chief Electoral Officer               	Election Act 
           Alberta             	(Section 139)
 
Disclaimer
I,    (print name of candidate)     having been declared elected as the 
candidate who received the largest number of votes in the election held 
for the electoral division of    (print name of electoral division)  , and 
not at this time having yet become the Member of the Legislative 
Assembly for that electoral division, pursuant to section 1(2) of the 
Legislative Assembly Act, do hereby disclaim my right to become a 
Member of the Legislative Assembly.
   (NAME OF DISCLAIMER (print))    	    (SIGNATURE)      
   (ELECTORAL DIVISION (print))    
   (NAME OF WITNESS (print))                       (SIGNATURE)       
   (ADDRESS OF WITNESS (print))    
Filed at my office this        day of             , 20    
      (CHIEF ELECTORAL OFFICER)    
Form 34
Chief Electoral Officer               	Election Act 
           Alberta             	(Section 142)
 
Returning Officer's Affidavit
I,            (Print Name)             , Returning Officer for the Electoral 
Division of                                 do Solemnly Swear (or Affirm):
THAT on the                day of                      , 20      I submitted the 
statements called for and my return in respect of the election held on 
the               day of                    , 20     , to the Chief Electoral Officer 
and that the statements and return are to the best of my knowledge and 
belief, correct and true.
THAT the ballot boxes, ballots and all other election material required 
to be returned have been transmitted to the Chief Electoral Officer in 
accordance with the Election Act.
SO HELP ME GOD 
(Omit if Affirmed)
SWORN (or Affirmed) BEFORE ME	) 
 at the                 of               , in the 	) 
Province of Alberta, this         day 	) 	   (Signature of Returning Officer)  
of                        , 20         .	)
	)  
(Justice of the Peace, Commissioner	)  
for Oaths or Notary Public)	)
Form 35
Chief Electoral Officer                	Election Act 
           Alberta             	(Section 186)
 
Form of Petition Controverted Election
In the Court of Queen's Bench, Judicial District of 	
Between       (Print Name of Petitioner)    , Petitioner,
and
(Print Name of Respondent)    , Respondent,
The petition of    (Petitioner)    of   (Residence and Occupation)     
showeth:
1.	An election was held on the   (Polling Day)   day of  (Month)     
20    for the Electoral Division of                     at which 
   (Respondent)     was a candidate and has been returned as the 
person elected at that election.
2.	The petitioner was a qualified elector at that election (or the 
petitioner was a defeated candidate at that election).
3.	The petition says (state here the facts and grounds on which the 
petitioner relies).
Wherefore the petitioner prays that it may be declared that the
election of     (Respondent)     is void and that it be set aside.
Dated this               day of                   , 20        
            (Signature of Petitioner)            


--------------------------------
Alberta Regulation 214/2004
Election Act
FEES AND EXPENSES AMENDMENT REGULATION
Filed: September 29, 2004
Made by the Lieutenant Governor in Council (O.C. 451/2004) on September 29, 2004 
pursuant to section 207 of the Election Act. 
1   The Fees and Expenses Regulation (AR 173/2004) is 
amended by this Regulation.

2   The following is added after section 9:
Senatorial Selection Act Fees
9.1(1)  If an election under the Senatorial Selection Act is to be 
held in conjunction with a general election under the Election Act, 
in addition to fees payable under sections 1 to 10, fees under this 
section may be paid for duties performed relating to the conduct of 
an election under the Senatorial Selection Act.
(2)  A returning officer may be paid the following:
	(a)	a fee of $510 if a writ of election is issued but no poll is 
held;
	(b)	a fee of $1505 if a writ of election is issued and a poll is 
held, including training of election staff and the conduct 
of the official count;
	(c)	a fee of $0.05 per name included in the list of electors 
on polling day.
(3)  An election clerk may be paid the following:
	(a)	a fee of $375, where a writ of election is issued and no 
poll is held;
	(b)	a fee of $995 if a writ of election is issued and a poll is 
held, including training of election staff and the conduct 
of the official count;
	(c)	a fee of $0.04 per name included in the list of electors 
on polling day.
(4)  A supervisory deputy returning officer may be paid a basic fee 
of $75 for duties performed on polling day or on each advance 
polling day.
(5)  An administrative assistant may be paid the following:
	(a)	a fee of $835 for duties performed on a full-time basis 
in the returning officer's office where a writ of election 
is issued and a poll is held;
	(b)	a fee to be prorated at a daily rate, as approved by the 
Chief Electoral Officer, for duties performed on a 
part-time basis in the returning officer's office where a 
writ of election is issued and a poll is held;
	(c)	a fee of $290 for duties performed on a full-time basis 
where a writ of election is issued and no poll is held;
	(d)	a fee to be prorated at a daily rate, as approved by the 
Chief Electoral Officer, for duties performed on a 
part-time basis, where a writ of election is issued but no 
poll is held.
(6)  A registration officer may be paid a basic fee of $70 for duties 
performed on polling day or on each advance polling day.
(7)  A deputy returning officer may be paid the following:
	(a)	a basic fee of $60 for duties performed on polling day;
	(b)	a fee of $180 to conduct an advance poll.
(8)  A poll clerk may be paid the following:
	(a)	a fee of $50 for duties performed on polling day;
	(b)	a fee of $150 for advance poll duties.

3   Section 10 is amended by adding the following before 
subsection (1):
(0.1)  This section applies with respect to an election under the 
Election Act and to an election under the Senatorial Selection Act 
held in conjunction with a general election under the Election Act.



Alberta Regulation 215/2004
Senatorial Selection Act 
Election Act
SENATE NOMINEE REGULATION
Filed: September 29, 2004
Made by the Lieutenant Governor in Council (O.C. 453/2004) on September 29, 2004 
pursuant to section 29 of the Senatorial Selection Act and section 207 of the Election 
Act. 
Table of Contents
	1	Application
	2	Forms
	3	Additional forms
	4	Term of Senate nominee
	5	Interpretation
	6	Consequential amendments
	7	Expiry


Application
1   This Regulation applies to an election under the Senatorial 
Selection Act that is to be held in conjunction with a general election 
under the Election Act.
Forms
2   The forms, oaths and notices required under the Senatorial 
Selection Act are set out in the Schedule.
Additional forms
3   In addition to the forms prescribed in the Schedule,
 	(a)	Forms 3, 7, 11, 15, 17 to 24, 27, 29, 30 and 35 of the Election 
Act Forms Regulation under the Election Act may be used, 
without making any specific references to the Senatorial 
Selection Act, for the purposes of the election under the 
Senatorial Selection Act and the general election under the 
Election Act;
	(b)	Forms 1 to 20 as set out in the Schedule must be used instead 
of Forms 1, 2, 4 to 6, 8 to 10, 12 to 14, 16, 25, 26, 28 and 31 
to 34 of the Election Act Forms Regulation under the 
Election Act for the purposes of the election under the 
Senatorial Selection Act and the general election under the 
Election Act.
Term of Senate nominee
4   The term of a Senate nominee commences on the day the person is 
declared elected in accordance with the Senatorial Selection Act and 
expires 6 years from that date.
Interpretation
5(1)  For greater certainty,
	(a)	"polling day" means the day fixed for voting at an election;
	(b)	"polling place" means a polling place as defined in the 
Election Act and includes a polling station as defined in that 
Act.
(2)  In the event that 2 or more candidates received the same number of 
votes, and if it is necessary to determine which candidate is elected, the 
procedure outlined under section 21(4) of the Senatorial Selection Act 
applies in order to determine which candidate is elected.
(3)  This section expires in accordance with section 29(2) of the 
Senatorial Selection Act.
Consequential amendments
6   The Senatorial Selection Regulation (AR 121/98) is 
amended by renumbering section 1 as section 1.1 and by 
adding the following before section 1.1:
Application
1   This Regulation applies to an election under the Senatorial 
Selection Act that is to be held in conjunction with general 
elections under the Local Authorities Election Act.
Expiry
7   For the purpose of ensuring that this Regulation is reviewed for 
ongoing relevancy and necessity, with the option that it may be 
repassed in its present or an amended form following a review, this 
Regulation expires on December 31, 2010.
Schedule  
 
Form 1

Province of Alberta	Senatorial Selection Act 
	(Section 5)    
 

WRIT UNDER THE SENATORIAL SELECTION ACT
        Canada 
Province of Alberta
Elizabeth The Second, by the Grace of God, of the United 
Kingdom, Canada and her other Realms and Territories, Queen, 
Head of the Commonwealth, Defender of the Faith.
To    (Name of Chief Electoral Officer)   , Chief Electoral Officer, 
in the Province of Alberta, Greeting:
We command you that, notice of the time and place of election 
being given, you do cause an election to be held to elect      
person(s) in accordance with the Senatorial Selection Act, and you 
do cause a nomination of a candidate(s) to be held on the date fixed 
for nominations for the next general election under the Election Act 
and in the event of a poll being granted you do cause a poll to be 
taken on the date fixed for voting for the next general election 
under the Election Act and you do cause the name of the person(s) 
so elected by the electors of the Province of Alberta to be certified 
to the President of the Executive Council.
Dated at the City of Edmonton in the Province of Alberta, this 
           day of             ,     .
            By Order:
Lieutenant Governor
Received the writ on the        day of       ,     .
Chief Electoral Officer
Form 2
Chief Electoral Officer	Senatorial Selection Act
        Alberta	(Section 46)
 
Senate Nominee Election 
Proclamation
For the purpose of electing        person(s) according to the Senatorial 
Selection Act whose name(s) is (are) to be submitted by the 
Government of Alberta to the Queen's Privy Council for Canada as a 
person(s) who may be summoned to the Senate of Canada for the 
purpose of filling a vacancy or vacancies relating to Alberta, Public 
Notice is hereby given to the electors that the following are fixed 
pursuant to the Senatorial Selection Act:
Nomination of Candidates
Commencing immediately and continuing until 2:00 p.m. on the date 
fixed for nominations for the next general election under the Election 
Act, excluding Saturdays, Sundays and holidays, nomination papers 
may be filed with the Office of the Chief Electoral Officer during 
normal business hours at [Published Address], for a candidate under 
the Senatorial Selection Act.
Advance Polls
Advance Polls will be held in each electoral division at the locations 
designated and on the dates fixed for Advance Polls for the next 
general election under the Election Act.
Polling Day
Voting will take place on the date fixed for voting for the next general 
election under the Election Act.
Announcement of Official Results
The announcement of official results will take place at the Office of 
the Chief Electoral Officer 10 days after the polling date fixed for the 
next general election under the Election Act.
Additional information concerning Senate Nominee election may be 
obtained from the Office of the Chief Electoral Officer, [Published 
Address] [Published Telephone Number], or from the Returning 
Officer in the applicable Electoral Division:
[Returning Officer's Name, Electoral Division]
[Published Address] 
[Published Telephone Number]
Issued    (Date)    by    (Chief Electoral Officer)   
God Save the Queen
Form 3
Chief Electoral Officer	Senatorial Selection Act
        Alberta	(Section 11)
 
Senate Nominee Election 
Nomination Paper
The electors whose names appear on the attached lists hereby 
nominate:
                         (Given Name/Initial(s)/Surname)	
of  (Address within Alberta where documents may be served and 
notices given)  as a Candidate for the purpose of electing a person 
according to the Senatorial Selection Act, whose name is to be 
submitted by the Government of Alberta to the Queen's Privy Council 
for Canada as a person who may be summoned to the Senate of 
Canada for the purpose of filling a vacancy relating to Alberta, and that 
they desire the person to be described on the ballot paper as:
  (Any combination of Given Name, Initial(s) or Nickname and Surname)   
representing              (Registered Political Party or independent)                
Declaration of Candidate and  
Appointment of Official Agent
I,    (Candidate)   , declare that I am eligible according to the 
Senatorial Selection Act to be a Candidate and I consent to my 
nomination.
I appoint                             (Name)                                           of 
          (Address)          ,                  (Telephone Number)          , as my 
Official Agent.
I further declare that I am a registered candidate under the Election 
Finances and Contributions Disclosure Act and that (check one)
	(a)	? the attached certificate from (Registered Political Party) 
confirms my endorsement as the official Candidate under the 
Senatorial Selection Act.
or
	(b)	? I am an independent Candidate under the Senatorial 
Selection Act.
      (Date)      	      (Candidate's Signature)      
Receipt for Deposit and Nomination Paper
Received from           (Candidate or Official Agent)          the sum of 
$4,000 as a nomination deposit and the nomination paper filed 
pursuant to the Senatorial Selection Act.
        (Date)        	   (Chief Electoral Officer's Signature)   
Form 4
Chief Electoral Officer	Senatorial Selection Act
        Alberta	(Section 11)
	Page ____ of ____
 
Senate Nominee Election 
Nomination Paper - Declaration of Support
We the undersigned qualified electors of the Province of Alberta 
hereby nominate:
                      (Given Name/Initial(s)/Surname)                       of 
                                          (Address)                                           as a 
candidate under the Senatorial Selection Act, whose name is to be 
submitted to the Queen's Privy Council for Canada for the purpose of 
filling a vacancy in the Senate of Canada.

Printed Name 
of Elector
Address
Telephone 
Signature
Date




















Affidavit of Attesting Witness
I, the undersigned elector, swear (or solemnly affirm) that I witnessed 
the signatures of the electors recorded on this Nomination Paper.

SWORN (OR AFFIRMED) BEFORE	) 
ME at the                                         of	 ) 
                             , in the Province of 	 ) 
Alberta, this          day of           ,        .	 ) 
	 ) 
	     ) 
(Returning Officer, Justice of the Peace      	)	  (Signature of Attesting Witness)  
Commissioner for Oaths or Notary Public)	 )
Form 5
Chief Electoral Officer	Senatorial Selection Act
        Alberta	(Section 11)
 
Senate Nominee Election  
Candidate's Nomination  
Endorsement Certificate
I certify that                                         (Nominee)                            is a 
Candidate officially endorsed by the:
                        (Name of Registered Political Party)                       for 
an election under the Senatorial Selection Act.
      (Date)      	(Signature of authorized Representative
	of the Registered Political Party)          
Form 6
Chief Electoral Officer	Senatorial Selection Act 
      Alberta	(Section 14)    
 
Senate Nominee Election  
Acclamation
I hereby certify and declare that the person(s) elected for the Province 
of Alberta pursuant to the writ under the Senatorial Selection Act is 
(are):

    Name(s)                                                    Political Affiliation    
                                                                                                           
                                                                                                           
                                                                                                           

No other candidates having been nominated. 
or 
The other candidate(s) having withdrawn.
      (Date)                         (Signature of Chief Electoral Officer)   
Form 7
Chief Electoral Officer	Senatorial Selection Act
        Alberta	(Section 18)
 
Senate Nominee Election  
Official Agents of Nominated Candidates

Candidate and Political 
Affiliation
Official Agent/ 
Telephone No.
Campaign Address
                                    
                                   
                            
                           
                              
                             
                                    
                                   
                            
                           
                              
                             
                                    
                                   
                            
                           
                              
                              

	        (Signature of Chief Electoral Officer)   
Form 8
Chief Electoral Officer	Senatorial Selection Act
        Alberta	(Section 34)
 
Senate Nominee Election  
Notice of Poll Being Granted  
and Candidates Nominated
PUBLIC NOTICE is hereby given to the electors of the Province of 
Alberta that a poll has been demanded at the election now pending 
under the Senatorial Selection Act and that I have granted such poll; 
and further that the persons duly nominated as candidates at the said 
election and for whom votes will be received are:

Name	Political affiliation      
                                                	                                                 
                                                	                                                 
                                                	                                                 
                                                	                                                 
                                                	                                                 
                                                	                                                 

       (Date)                               	(Signature of Chief Electoral Officer)

Form 9 
 
Senatorial 
Selection 
   (year)   

Back of Ballot


Initials of DRO
Number from Poll 
Book _____



First Fold 
 
Printed by 
   (Printer's 
name)   
Second Fold
Form 10



Senatorial Selection

This ballot shall not be marked for
more than  (number of candidate(s) to be 
elected)  candidate(s).
Front of Ballot

Name of Candidate 
Political Party or Independent



Name of Candidate 
Political Party or Independent



Name of Candidate 
Political Party or Independent



Name of Candidate 
Political Party or Independent



Name of Candidate 
Political Party or Independent

Form 11
Chief Electoral Officer	Senatorial Selection Act
        Alberta	(Section 20)
 
Senate Nominee Election 
Affidavit of Printer
I,                                                    , swear (or solemnly affirm):
that by direction of the Chief Electoral Officer for the Province of 
Alberta I printed ballots for use at the election to be held under the 
Senatorial Selection Act on the                 day of             ,      ;
that the attached sample shows the description of the ballots printed by 
me;
that I supplied the Chief Electoral Officer with   (number of ballots)   
of such ballots; and
that no other of such ballots were printed by or supplied by me to 
anyone.
SWORN (OR AFFIRMED) BEFORE ME at
the       (City, Town, etc.)                 
of    (Name of City, Town, etc.)       
in the Province of Alberta, this	                      (Signature of Printer)        
             day of                      ,           .
                                                          
(Justice of the Peace, Commissioner
       for Oaths or Notary Public)
Form 12
Chief Electoral Officer	Senatorial Selection Act
        Alberta	
 
Direction for Guidance of Voters
THE VOTER MUST vote for not more than        candidate(s) by the 
use of the "X" mark opposite the name(s) of the candidate(s) of the 
voter's choice in the white circle provided.
THE VOTER IS to refold the ballot and return it to the Deputy 
Returning Officer for removal of counterfoil and placement of ballot in 
ballot box.
IF THE VOTER SPOILS a ballot, the voter may return it to the 
Deputy Returning Officer who will give the voter another ballot.

SENATE NOMINEE ELECTION
THE VOTER MUST vote for not more than    (number of 
candidates)    by the use of the "X" mark opposite the name(s) of 
the candidate(s) of the voter's choice in the white circle provided.

Candidate



Candidate



Candidate


A ballot marked in more than    (number of candidates)    circles 
will not be counted.
Form 13
Chief Electoral Officer	Senatorial Selection Act
        Alberta

 
Senate Nominee Election 
Special Ballot
Initials of 
returning 
officer 
                         
   
election clerk 
or 
administrative 
assistant

Serial No. 
                 
Supplied by the Chief Electoral Officer                     (year)    

Form 14


Print the name(s) of up to    (number of person(s) to be 
elected)    different Senate Nominee candidates on the lines 
below 




I vote for: 
 
                                                                                          



I vote for: 
 
                                                                                          



I vote for: 
 
                                                                                          


Form 15
Chief Electoral Officer 	Senatorial Selection Act
        Alberta
 
Senate Nominee Election 
Special Ballot Envelope
Insert the marked ballot into this envelope and seal it.
Insert this envelope into the Special Ballot Certificate Envelope and 
seal it.
Form 16
Chief Electoral Officer	Senatorial Selection Act
        Alberta
 
Senate Nominee Election 
Statement of Poll
Electoral Division of                 (Name of Electoral Division)           
Polling Station Number                    Location                                   

Number of Ballots Received from Returning Officer                       1   
Number of Ballots Counted for Each Senate Nominee Candidate 

               Candidate                         Number of Votes    (R.O. Use Only)
                                                             
                                                             
                                                             
                                                             
                                                            
                             
                             
                             
                             
                            

Total Votes Cast for Candidates
                            

Number of Valid Ballots 
	 2                           

Number of Spoiled Ballots
(Ballots spoiled by electors and  
returned to DRO) 	3                          

Number of Declined Ballots
(Ballots returned to DRO by  
electors who declined to vote) 	4                           

Number of Ballots Not Used
(Unused ballots returned to RO) 	5                           

Number of Rejected Ballots
(Ballots deposited in ballot box  
but not counted as valid) 	6                           

Number of Ballots Removed from  
Polling Place	7                           

                                              Total	8                           
                   (Sum of 2, 3, 4, 5, 6, 7) 
8                           
                                                                        To balance, Line 8 equals Line 1
Total number of names on the List of Electors  
including all those sworn in:	                                
Number of voters recorded in the Poll Book as  
having voted:	                              
  (Signature of Poll Clerk)        (Signature of Deputy Returning Officer)       (Date)  
Form 17
Chief Electoral Officer	Senatorial Selection Act
        Alberta	(Section 21)
 
Senate Nominee Election 
Certificate and Return
I hereby certify that at the election held under the Senatorial Selection 
Act on the              day of                     ,     , the following candidates 
received the number of votes set opposite their names:

Name of Candidate
Political Affiliation
Votes Received












I hereby certify that the person(s) elected under the Senatorial 
Selection Act is(are):

Name
Political Affiliation








Dated at                     , Alberta
      (Date)        	   (Signature of Chief Electoral Officer)    




Form 18
Chief Electoral Officer				Senatorial Selection Act
        Alberta	(Section 21)
 
Senate Nominee Election 
Statement of Official Results
		Page __ of __
Respecting votes polled and ballots used at the polls for the electoral division of                                            
at the election held on the                day of                    ,                       .
Poll
Number
Name of 
Poll

Name, political affiliation and number of votes polled for EACH 
candidate in the order that they appeared on the ballot
N
u
m
be
r 
of 
V
ot
es 
C
as
t
(T
ota
l 
of 
Co
lu
m
ns 
A 
- 
K)
Nu
mbe
r of 
Vali
d 
Ball
ots  
(Fro
m 
State
ment 
of 
Poll)
Number 
of 
Spoiled 
Ballots
(Ballots 
spoiled by 
electors 
and 
returned to 
DRO)
Numb
er of 
Declin
ed 
Ballot
s 
(Ballots 
returned 
to DRO 
by 
electors 
who 
declined 
to vote)
Nu
mbe
r of 
Ball
ots 
Not 
Use
d
(Unu
sed 
ballot
s 
retur
ned 
to 
RO)
Nu
mbe
r of 
Reje
cted 
Ball
ots
(Ball
ots 
depos
ited 
in 
ballot 
box 
but 
not 
count
ed as 
valid)
N
u
m
be
r 
of 
B
al
lo
ts 
R
e
m
o
ve
d 
fr
o
m 
P
ol
li
n
g 
Pl
ac
e
Nu
mbe
r of 
Ball
ots 
Sent 
to  
Eac
h 
Poll
(Tota
l of 
Colu
mns 
3, 4, 
5, 6 
,7 & 
8)


Total Number of 
Names on 
List of Electors 
(including those 
sworn in at 
advance & 
polling day)











































1
A
B
C
D
E
F
G
H
I
J
K
2
3
4
5
6
7
8
9


































































               Subtotal/Total




























Certified Correct 
          (Signature of Returning Officer)



Form 19
Chief Electoral Officer                         Senatorial Selection Act
        Alberta                                                                (Section 23)
 
Senate Nominee Election 
Disclaimer

I,     (Print Name of Disclaimant)    , having been declared elected at 
the     (Day/Month/Year)     election under the Senatorial Selection 
Act, request that my name not be submitted to the Queen's Privy 
Council for Canada, or that, if my name has been submitted, the 
submission be withdrawn; and do hereby disclaim my right to have 
my name forwarded to the Queen's Privy Council for Canada.
   (Print Name of Disclaimant)                                 (Signature)     
     (Print Name of Witness)                                   (Signature)     
    (Print Address of Witness)    
         Filed at my office this                day of                     ,       .
                                             (Signature of Chief Electoral Officer



Form 20
Chief Electoral Officer				Senatorial Selection Act
        Alberta	(Section 21, 51)
 
Senate Nominee Election 
Tabulation of Official Results
		Page __ of __
Respecting votes and ballots used at the election held according to the Senatorial Selection Act on                day of                    ,                       .
Electoral Division

Name, political affiliation and number of votes polled for EACH 
candidate in the order that they appeared on the ballot
N
u
m
be
r 
of 
V
ot
es 
C
as
t
(T
ota
l 
of 
Co
lu
m
ns 
A 
- 
K)
Nu
mbe
r of 
Vali
d 
Ball
ots  
(Fro
m 
State
ment 
of 
Poll)
Number 
of 
Spoiled 
Ballots
(Ballots 
spoiled by 
electors 
and 
returned to 
DRO)
Numb
er of 
Declin
ed 
Ballot
s 
(Ballots 
returned 
to DRO 
by 
electors 
who 
declined 
to vote)
Nu
mbe
r of 
Ball
ots 
Not 
Use
d
(Unu
sed 
ballot
s 
retur
ned 
to 
RO)
Nu
mbe
r of 
Reje
cted 
Ball
ots
(Ball
ots 
depos
ited 
in 
ballot 
box 
but 
not 
count
ed as 
valid)
N
u
m
be
r 
of 
B
al
lo
ts 
R
e
m
o
ve
d 
fr
o
m 
P
ol
li
n
g 
Pl
ac
e
Nu
mbe
r of 
Ball
ots 
Sent 
to 
Poll
s
(Tota
l of 
Colu
mns 
3, 4, 
5, 6 
,7 & 
8)

Total Number of 
Names on 
List of Electors 
(including those 
sworn in at 
advance & 
polling day)









































1
A
B
C
D
E
F
G
H
I
J
K
2
3
4
5
6
7
8
9































































               Subtotal/Total



























Certified Correct 
          (Signature of Chief Electoral Officer)



Alberta Regulation 216/2004
Wildlife Act
WILDLIFE AMENDMENT REGULATION
Filed: September 29, 2004
Made by the Minister of Sustainable Resource Development (M.O. 40/04) on 
September 29, 2004 pursuant to sections 12, 23 and 103 of the Wildlife Act. 
1   The Wildlife Regulation (AR 143/97) is amended by this 
Regulation.

2   Section 36(3)(d)(ii) is repealed and the following is 
substituted:
	(ii)	the snare is a device designed and set to capture that kind of 
fur-bearing animal by the neck and, where applicable, the 
specific use of a snare on the land referred to in subsection 
(1) has been authorized in writing by the person who 
provided the relevant authorization referred to in subsection 
(1).



3   Schedule 15 is amended
	(a)	in section 7(1) by striking out "The" and substituting 
"Subject to, and except to the extent that there is no open 
season by virtue of the application of, subsection (3), the";
	(b)	in section 7(2) by striking out "subsection (1)" and 
substituting "subsections (1) and (3)";
	(c)	in section 7(3)
	(i)	by striking out all the words preceding clause 
(a) and substituting the following:
(3)  The following open season quotas, which apply 
relative to either or both sexes of cougar as indicated, are 
established and the Minister may close an open cougar 
hunting season in a specific Cougar Management Area 
whenever either the female number quota or the male 
number quota for that area is first reached or, if there is an 
open season for only one sex, the number quota for that 
sex is reached:
	(ii)	in clause (a) by striking out "2 female cougar or 3 
cougar" and substituting "1 female cougar";
	(iii)	in clause (b) by striking out "3 female cougar or 5 
cougar" and substituting "2 female cougar or 1 male 
cougar";
	(iv)	in clause (c) by striking out "3 female cougar or 6 
cougar" and substituting "2 female cougar or 1 male 
cougar";
	(v)	in clause (d) by striking out "2 cougar" and 
substituting "1 male cougar";
	(vi)	in clause (e) by striking out "5 female cougar or 10 
cougar" and substituting "3 female cougar or 4 male 
cougar";
	(vii)	in clause (f) by striking out "3 cougar" and 
substituting "1 male cougar";
	(viii)	in clause (g) by striking out "7 female cougar or 14 
cougar" and substituting "4 female cougar or 4 male 
cougar";
	(ix)	in clause (h) by striking out "9 female cougar or 16 
cougar" and substituting "4 female cougar or 5 male 
cougar";
	(x)	in clause (i) by striking out "5 female cougar or 10 
cougar" and substituting "4 female cougar or 4 male 
cougar";
	(xi)	in clause (j) by striking out "20 female cougar or 
28 cougar" and substituting "12 female cougar or 12 
male cougar";
	(xii)	in clause (k) by striking out "3 female cougar or 7 
cougar" and substituting "2 female cougar or 3 male 
cougar";
	(xiii)	in clause (l) by striking out "2 female cougar or 4 
cougar" and substituting "1 female cougar or 2 male 
cougar";
	(xiv)	in clause (m) by striking out "3 female cougar or 5 
cougar" and substituting "1 female cougar or 2 male 
cougar";
	(xv)	in clause (n) by striking out "5 female cougar or 10 
cougar" and substituting "3 female cougar or 4 male 
cougar";
	(xvi)	in clause (o) by striking out "6 female cougar or 12 
cougar," and substituting "3 female cougar or 4 male 
cougar";
	(xvii)	by striking out "whichever of the female number and 
the total number of cougar are killed first";
	(d)	in section 7(4)
	(i)	by striking out "licences and" and substituting 
"licences that are not allocated licences and that are";
	(ii)	by striking out ", plus cougars that have been 
estimated to have been removed from the wildlife 
population by the actions of any person, including a 
collision with any vehicle,";
	(e)	in section 9(1)(d)
	(i)	in subclause (i) by striking out "WMU 511, 512, 516, 
517, 518, 519, 520, 528, 529, 530, 531, 532, 540, 542 or 
544" and substituting "Fur Management Zone 1 or 2";
	(ii)	in subclause (i)(A) by striking out "10" and 
substituting "6";
	(iii)	in subclause (i)(B)
	(A)	by striking out "10" and substituting "6";
	(B)	by striking out "5" wherever it occurs and 
substituting "3";
	(iv)	by repealing subclause (ii);
	(v)	in subclause (ii.1) by striking out "or in 
WMU 357, 358, 359, 522, 523, 526 or 527" and 
substituting ", 4 or 5";
	(vi)	in subclause (ii.1)(A) by striking out "6" and 
substituting "4";
	(vii)	in subclause (ii.1)(B)
	(A)	by striking out "6" and substituting "4";
	(B)	by striking out "3" wherever it occurs and 
substituting "2";
	(viii)	by repealing subclause (iii);
	(f)	in section 9(1)(e)
	(i)	in subclause (i) by striking out "2 or in WMU 511, 
512, 516, 517, 518, 519, 529, 530 or 531" and 
substituting "1 or in WMU 350, 351, 357, 358, 359, 
522, 523, 524, 525, 526, 527, 534, 535, 536, 537 or 
539";
	(ii)	in subclause (i)(A) by striking out "8" and 
substituting "5";
	(iii)	in subclause (i)(B)
	(A)	by striking out "8" and substituting "5";
	(B)	by striking out "4" wherever it occurs and 
substituting "2";
	(iv)	in subclause (ii) by striking out "349, 353, 354, 
355, 356, 360 or 521" and substituting "520, 528, 
540, 542 or 544";
	(v)	in subclause (ii)(A) by striking out "4" and 
substituting "6";
	(vi)	in subclause (ii)(B)
	(A)	by striking out "4" and substituting "6";
	(B)	by striking out "2" wherever it occurs and 
substituting "3";
	(vii)	in subclause (iii) by striking out "350 or 351" and 
substituting "349, 353, 354, 355, 356, 360 or 521";
	(viii)	in subclause (iii)(A) by striking out "5" and 
substituting "4";
	(ix)	in subclause (iii)(B) by striking out "5" and 
substituting "4";
	(x)	by repealing subclause (iv);
	(g)	in section 15 by striking out footnote 3 and 
substituting the following:
3   This season does not apply to WMU 314, 316, 318, 320, 
322, 324, 330, 332, 334, 336, 337, 338, 348, 360, 410, 412, 
414, 416, 417, 418, 507, 508 or 521.  The season for wolves in 
those WMUs is from October 1 to March 31.  The season for 
coyotes in those WMUs is from October 1 to February 28.
	(h)	by repealing Table 5 and substituting the following:



TABLE 5 
 
FUR SEASONS 


FUR 
MANAGEMENT 
ZONE 1
FUR 
MANAGEMENT 
ZONE 2
FUR 
MANAGEMENT 
ZONE 3
FUR 
MANAGEMENT 
ZONE 4
FUR 
MANAGEMENT 
ZONE 5
FUR 
MANAGEMENT 
ZONE 6
FUR 
MANAGEMENT 
ZONE 7
FUR 
MANAGEMENT 
ZONE 8
BADGER
CLOSED
CLOSED
D1 - Ap15
D1 - Ap15
D1 - Ap15
D1 - Ap15
D1 - Ap15
D1 - M31
BEAVER
O1 - Ma15
O1 - Ma15
O1 - Ma15
O1 - Ma15
O1 - Ma31
O15 - Ma15
O15 - Ap30
O15 - Ap30
BOBCAT
CLOSED
CLOSED
CLOSED
CLOSED
CLOSED
D1 - J31
CLOSED
N1 - F28
COYOTE
O1 - F28
O1 - F28
O1 - F28
D1 - F283
D1 - F28
D1 - F283
O1 - F28
O1 - F28
FISHER
N1 - J312,5
N1 - J312,5
N1 - J312
N1 - J312
N1 - J312
CLOSED
CLOSED
CLOSED
RED/ARCTIC 
FOX
O1 - J314
O1 - J314
O1 - F28
O1 - F28
O1 - F28
O1 - F28
O1 - F28
O1 - F28
LYNX
D1 - F152
D1 - F152
D1 - F152
D1 - F152
D1 - F152
D1 - F152
CLOSED
CLOSED
MARTEN
N1 - J315
N1 - J315
N1 - J312
N1 - J31
N1 - J31
N1 - J31
CLOSED
CLOSED
MINK
N1 - J315
N1 - J315
N1 - J31
N1 - J31
N1 - J31
N1 - J31
N1 - J31
N1 - J31
MUSKRAT
O1 - Ma15
O1 - Ma15
O1 - Ma15
O1 - Ma15
O1 - Ma15
O15 - Ma15
O15 - Ap30
O15 - Ap30
OTTER
D1 - Ma151
D1 - Ma151
D1 - Ma151
D1 - Ma151,7
CLOSED
CLOSED
CLOSED
CLOSED
RED 
SQUIRREL
N1 - F28
N1 - F28
N1 - F28
N1 - F28
N1 - F28
N1 - F28
N1 - F28
N1 - F28
WEASEL
N1 - F28
N1 - F28
N1 - F28
N1 - F28
N1 - F28
N1 - F28
N15 - F14
N15 - F14
WOLF
O1 - M31
O1 - M31
O1 - M31
D1 - M313
D1 - M31
D1 - F283
O1 - F28
O1 - F28
WOLVERINE
N1 - J311,5
N1 - J311,5
N1 - J311
N1 - J311
N1 - J311
N1 - J311
CLOSED
CLOSED


Alberta Regulation 217/2004
Insurance Act
AUTOMOBILE INSURANCE PREMIUMS AMENDMENT REGULATION
Filed: September 30, 2004
Made by the Lieutenant Governor in Council (O.C. 454/2004) on September 30, 2004 
pursuant to section 656 of the Insurance Act. 
1   The Automobile Insurance Premiums Regulation 
(AR 124/2004) is amended by this Regulation.

2   Schedule 1, section 1(1)(a), is repealed and the following 
is substituted:


Definitions
1(1)  In this Schedule,
	(a)	"at-fault claim" means, in respect of liability described 
in section 627 of the Act or under the same or 
equivalent coverage in any other jurisdiction, inside or 
outside Canada,
	(i)	a claim paid in respect of that liability for which 
the driver is wholly or partially at fault, and
	(ii)	a claim made in respect of which the insurer has 
reasonably determined that a payment will or is 
likely to be made as a result of the fault, whole or 
partial, of the driver,
		but does not include
	(iii)	a claim in respect of which the policyholder has 
repaid the insurer for the amount of the claim 
within 90 days after the claim was paid by the 
insurer, or
	(iv)	a claim in respect of which the insurer has not 
increased the premium payable by the policyholder 
on the first renewal after the claim is paid;

3   Schedule 1, section 5(3) is repealed and the following is 
substituted:
(3)  The grid step is first established for a driver by moving down 
one grid step from grid step zero for each year of driving 
experience to a maximum of 15 years' driving experience, then, if 
applicable, moving up 5 grid steps for each at-fault claim during 
the 6 years preceding the relevant date.

4   This Regulation comes into force on October 1, 2004.


--------------------------------
Alberta Regulation 218/2004
Child, Youth and Family Enhancement Act
CHILD, YOUTH AND FAMILY ENHANCEMENT 
AMENDMENT REGULATION
Filed: September 30, 2004
Made by the Minister of Children's Services (M.O. 36/04) on September 24, 2004 
pursuant to section 131(2) of the Child, Youth and Family Enhancement Act. 
1   The Child, Youth and Family Enhancement Regulation 
(AR 160/2004) is amended by this Regulation.

2   Under Schedule 1, Form 16 is amended by striking out "a 
foster parent for more than 6 of the 12 months preceding a director's 
decision" and substituting "a foster parent".

3   Schedule 2 is amended by adding the following after 
clause (e):
	(f)	Sifton Family and Youth Services (Lethbridge).


--------------------------------
Alberta Regulation 219/2004
Cancer Programs Act
CANCER PROGRAMS AMENDMENT REGULATION
Filed: September 30, 2004
Made by the Minister of Health and Wellness (M.O. 102/2004) on September 28, 
2004 pursuant to sections 16 and 22 of the Cancer Programs Act. 
1   The Cancer Programs Regulation (AR 242/98) is 
amended by this Regulation.

2   The Schedule is repealed and the following Schedule is 
substituted:
Schedule 
Drug
Group
Dosage 
Form 

Criteria
13 Cis-RETINOIC ACID
2
capsules
Pediatrics 
- restricted to the treatment 
of advanced stage 
neuroblastoma following 
POG/CCG Protocols 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the pediatric tumour program
ALL-TRANS RETINOIC ACID
2
capsules
 - restricted to treatment of 
acute promyelocytic 
leukemia 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the hematology/lymphoma 
tumour program or the 
pediatric tumour program
AMSACRINE
2
injectable

ANAGRELIDE
1
capsules
 - for thrombocytosis due to 
myeloproliferative disorder 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the hematology/lymphoma 
tumour program
ANASTROZOLE
1
tablets
 - for post-menopausal 
patients with receptor-
positive, metastatic breast 
cancer who have progressed 
or have experienced severe 
side effects on prior hormone 
therapy

2
tablets
Breast Cancer Adjuvant 
 - for adjuvant use in invasive 
breast cancer patients who 
are post-menopausal, 
hormone receptor positive in 
whom tamoxifen is 
contraindicated or not 
tolerated 
 - prescribing limited to 
written authorization by 
named physicians as 
recommended by the breast 
tumour program
ASPARAGINASE
1
injectable

BCG
1
injectable
 - bladder carcinoma
BICALUTAMIDE
1
tablets
 - restricted to patients who 
are intolerant to Nilutamide 
or Flutamide 
 - approved dosage is 50 mg 
daily
BLEOMYCIN
1 
2
injectable 
pump

BUSERELIN
1
injectable
- prostate cancer 
 - Restricted to: 
Stage II (T2a-T2c): 
Neoadjuvant use pre RT (2 
months pre and during RT). 
Neoadjuvant use pre radical 
prostatectomy (4 months pre) 
Stage III (T3a-T4b): 
Neoadjuvant use pre RT (2 
months pre and during RT). 
Adjuvant use (3 years post 
RT)



Stage IV (N1-N3) 
(M1-M1c): As monotherpy 
in medical castration. 
In total androgen blockade 
(medical castration and 
nonsteriodal antiandrogen)



 - Guidelines for LHRH use 
in the above stated stages 
include: LHRH agonists are 
indicated for use in patients 
at risk of thromboembolic 
disease, strokes (CVA), 
myocardial infarction and 
also for consideration in 
patients with dyslipidemia, 
hypertension, diabetes 
mellitus or where a patient is 
considered intolerant to 
cyproterone acetate or 
megestrol acetate
BUSULFAN
1
tablets

CAPECITABINE
2
oral
 - metastatic or advanced 
breast cancer (with or 
without prior anthracycline 
exposure) 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the breast tumour program

2
oral
 - option in first line 
treatment of advanced or 
metastatic colorectal cancer 
 - prescribing limited to 
written authorization by 
named physicians as 
recommended by the GI 
tumour program
CARBOPLATIN
1
injectable

CARMUSTINE
1
injectable, 
topical

CHLORAMBUCIL
1
tablets

CISPLATIN
1
injectable

CLADRIBINE
2
injectable, 
subcutane-
ous
 - restricted to treatment of 
hairy cell leukemia 
 - Waldenstrom's 
macroglobulinemia 
 - hematologic malignancies 
(histocytosis-X, cutaneous 
T-cell lymphoma, systemic 
mast cell disease) 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the hematology/lymphoma 
tumour program

3
injectable
POG Protocol 9720 
prescribing limited to written 
authorization by physicians 
recommended by the 
pediatric tumour program
CLODRONATE
1
oral
 - treatment of osteolytic 
bone lesions in metastatic 
breast cancer
CYCLOPHOSPHAMIDE
1
injectable, 
tablets

CYPROTERONE
1
tablets

CYTARABINE
1
injectable

CYTARABINE LIPOSOMAL
3
injectable
 - for intrathecal management 
of neoplastic meningitis due 
to solid tumours or 
lymphoma
DACARBAZINE
1
injectable

DACTINOMYCIN
1
injectable

DAUNORUBICIN
1
injectable

DEXAMETHASONE
1
injectable, 
tablets
 - antiemetic use NOT 
covered
DOCETAXEL
2
injectable
 - treatment of metastatic 
breast cancer after failure of 
any previous chemotherapy 
regimen 
- as a single agent or in 
combination, as an option for 
first line treatment of 
metastatic breast cancer 
 - only one taxane is to be 
administered to any one 
patient 
 - prescribing limited to 
written authorization by 
named physicians as 
recommended by the breast 
tumour program

2
injectable
Breast Neoadjuvant 
 - following a neoadjuvant 
anthracycline containing 
regimen in locally advanced 
(Stage IIIA or IIIB) breast 
cancer 
 - prescribing limited to 
written authorization by 
named physicians as 
recommended by the breast 
tumour program

2
injectable
Breast Adjuvant 
 - (with doxorubicin and 
cyclophosphamide (TAC)) 
for adjuvant treatment of 
node positive breast cancer 
 - prescribing limited to 
written authorization by 
named physicians as 
recommended by the breast 
tumour program

2
injectable
 - 2nd line therapy in patients 
with advanced or metastatic 
non-small cell lung cancer 
with good performance status 
(ECOG 0-2) and no 
symptomatic or uncontrolled 
brain metastases 
 - prescribing limited to 
written authorization by 
named physicians as 
recommended by the lung 
tumour program

2
injectable
Prostate Cancer 
- Docetaxel (with 
prednisone) as first-line 
treatment of hormone 
refractory prostate cancer 
- prescribing limited to 
written authorization by 
named physicians as 
recommended by the tumour 
program
DOXORUBICIN
1
injectable

DOXORUBICIN LIPOSOMAL
2
injectable
 - Kaposi's sarcoma

2
injectable
 - 2nd or 3rd line treatment of 
ovarian cancer, fallopian tube 
carcinoma and primary 
peritoneal neoplasms 
 - prescribing limited to 
written authorization by 
named physicians as 
recommended by the 
gynecology tumour program
EPIRUBICIN
2
injectable
Breast Cancer 
 - adjuvant (node positive) 
and neoadjuvant (stage II and 
III) treatment of pre- and 
post-menopausal breast 
cancer patients 
- adjuvant treatment of high 
risk (as defined by current 
Alberta Breast Cancer 
Program Guidelines), lymph 
node negative breast cancer 



- prescribing limited to 
written authorization by 
named physicians as 
recommended by the breast 
tumour program

2
injectable
Esophagogastric Cancer 
 - used (in combination with 
cisplatin and fluorouracil) in 
the treatment of locally 
advanced or metastatic 
esophagogastric cancer in 
patients with good 
performance status

3
injectable
NCIC MA21 Trial 
 - use as adjuvant treatment 
in NCIC MA21 Trial 
 - prescribing limited to 
written authorization by 
clinical trial principal 
investigator(s) or co-
investigators
ESTRAMUSTINE
1
capsules

ETOPOSIDE
1
injectable, 
capsules

EXEMESTANE
1
oral
 - for post-menopausal 
patients with 
receptor-positive, 
advanced/metastatic breast 
cancer that have progressed 
or have experienced severe 
side effects on prior hormone 
therapy
FLUDARABINE
2
injectable, 
tablets
 - previously treated or 
untreated chronic 
lymphocytic leukemia 
 - low grade lymphoma 
 - Waldenstrom's 
macroglobulinemia 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the hematology tumour 
program
FLUOROURACIL
1 
 
2
injectable, 
cream 
pump

FLUTAMIDE
1
tablets
 - prostate cancer
GEMCITABINE
2
injectable
Non-small Cell Lung Cancer 
 - patients who are unable to 
tolerate vinorelbine or 
paclitaxel containing 
regimens with documented 
reason for intolerance 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the lung tumour program

2
injectable
Bladder Cancer 
 - Gemcitabine/Cisplatin as 
first line chemotherapy in 
locally advanced/metastatic 
bladder cancer 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the GU tumour program

2
injectable
Pancreas 
 - locally advanced or 
metastatic adenocarcinoma 
of the pancreas 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the GI tumour program

2
injectable
Hematology 
 - Gemcitabine, 
Dexamethasone, Cisplatin 
for relapsed or refractory 
Hodgkins or Non-Hodgkins 
Lymphoma (GDP regimen) 
 - prescribing limited to 
written authorization by 
named physicians as 
recommended by the 
hematology/lymphoma 
program

2
injectable
Breast Cancer 
- Gemcitabine/Paclitaxel for 
treatment of metastatic breast 
cancer 
- prescribing limited to 
written authorization by 
named physicians as 
recommended by the breast 
tumour program
GOSERELIN
1
injectable
 - prostate cancer 
 - Restricted to: 
Stage II (T2a-T2c): 
Neoadjuvant use pre RT (2 
months pre and during RT). 
Neoadjuvant use pre radical 
prostatectomy (4 months pre) 
Stage III (T3a-T4b): 
Neoadjuvant use pre RT (2 
months pre and during RT). 
Adjuvant use (3 years post 
RT)



Stage IV (N1-N3) 
(M1-M1c): As monotherpy 
in medical castration 
In total androgen blockade 
(medical castration and 
nonsteriodal antiandrogen)



 - Guidelines for LHRH use 
in the above stated stages 
include: LHRH agonists are 
indicated for use in patients 
at risk of thromboembolic 
disease, strokes (CVA), 
myocardial infarction and 
also for consideration in 
patients with dyslipidemia, 
hypertension, diabetes 
mellitus or where a patient is 
considered intolerant to 
cyproterone acetate or 
megestrol acetate

2
injectable
 - breast cancer. 2nd line 
hormonal therapy for 
recurrent or metastatic 
disease in either or both 
estrogen and progesterone 
receptor positive pre and 
perimenopausal patients after 
tamoxifen failure 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the breast tumour program
HYDROCORTISONE SODIUM 
SUCCINATE
 
1
 
injectable
 
 - intrathecal use only
HYDROXYUREA
1
capsules

IDARUBICIN
3
injectable
POG Protocol 9720
- prescribing limited to 
written authorization by 
physicians recommended by 
the pediatric tumour program
IFOSFAMIDE
1 
2
injectable 
pump

IMATINIB
2
capsules
 - for surgically unresectable 
or metastatic gastrointestinal 
stromal tumour (GIST) 
 - prescribing limited to 
written authorization by 
named physicians as 
recommended by the tumour 
program

2
capsules
Hematology 
 - Philadelphia-chromosome 
positive leukemia (including 
disease situations such as 
first chronic phase chronic 
myelogenous leukemia 
(CML), accelerated phase 
CML, blast crisis phase 
CML, acute lymphoblastic 
leukemia, or other leukemias 
that have the characteristic 
t(9;22) translocation detected 
by cytogenetics, FISH 
analysis, or PCR-positive for 
bcr-abl oncogene)



 - prescribing limited to 
written authorization by 
named physicians as 
recommended by the 
hematology/lymphoma 
program
INTERFERON 
 
 
  - alpha 2a or 2b 
 
  - alpha 2b in new patients "03-
04"
1
injectable
 - cladribine-resistant hairy 
cell leukemia 
 - Kaposi's sarcoma 
 - chronic myelogenous 
leukemia 
 - metastatic renal cell 
carcinoma 

INTERFERON 
  alpha 2a ONLY
1
injectable
 - mycosis fungoides and 
sezary syndrome (cutaneous 
T-cell lymphomas) 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the hematology/lymphoma 
tumour program
INTERFERON 
 alpha 2b ONLY
1
injectable
- basal cell carcinoma 
 - adjuvant treatment of high 
risk melanoma

1
injectable
Superficial Bladder Cancer 
 - Interferon alone - second 
line treatment or first line in 
those with a documented 
intolerance or 
contraindication (i.e., 
immunosuppression or other) 
to BCG 
 - Interferon in combination 
with BCG - second line 
treatment

2
injectable
 - treatment of patients with 
malignant carcinoid and 
neuroendocrine 
gastroenteropancreatic 
tumours not amenable to 
surgical extirpation 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the GI and endocrine tumour 
programs

2
injectable
 - maintenance therapy in 
multiple myeloma patients 
who have achieved complete 
remission after high dose 
chemotherapy and 
autologous stem cell 
transplant



 - follicular lymphoma and 
need for therapy as indicated 
by any of: mass >7 cm or 3 
sites >3 cm, Bsx, 
splenomegaly @ umbilicus, 
compression syndromes (GI, 
GU, orbit), effusions 
cytopenias, Age < 70 yo



 - prescribing limited to 
written authorization by 
physicians recommended by 
the hematology/lymphoma 
tumour program
IRINOTECAN 
 
*  NOTE: 
Loperamide supplied by industry 
with this agent's use
2
injectable
Metastatic Colorectal Cancer 
 - first line (with 5FU and 
leucovorin) 
 - 2nd line after failure of 
thymidilate synthase 
inhibitors (e.g., 5 
fluorouracil, raltitrexed, or 
capecitabine) 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the GI tumour program

2
injectable
Pediatrics 
 - restricted to the treatment 
of high risk metastatic 
rhabdomyosarcomas 
following POG/CCG 
protocols 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the pediatric tumour program
LETROZOLE
1
tablets
 - first line therapy for 
hormone receptor positive 
post-menopausal metastatic 
breast cancer
LEUCOVORIN CALCIUM
1
injectable, 
tablets
 - rescue therapy for 
methotrexate only 
 - in combination with 5FU
LEUPROLIDE
1
injectable
 - prostate cancer 
 - Restricted to: 
Stage II (T2a-T2c): 
Neoadjuvant use pre RT (2 
months pre and during RT). 
Neoadjuvant use pre radical 
prostatectomy (4 months pre) 
Stage III (T3a-T4b): 
Neoadjuvant use pre RT (2 
months pre and during RT). 
Adjuvant use (3 years post 
RT)



Stage IV (N1-N3) 
(M1-M1c): As monotherpy 
in medical castration. 
In total androgen blockade 
(medical castration and 
nonsteriodal antiandrogen)



- Guidelines for LHRH use 
in the above stated stages 
include: LHRH agonists are 
indicated for use in patients 
at risk of thromboembolic 
disease, strokes (CVA), 
myocardial infarction and 
also for consideration in 
patients with dyslipidemia, 
hypertension, diabetes 
mellitus or where a patient is 
considered intolerant to 
cyproterone acetate or 
megestrol acetate
LOMUSTINE
1
capsules

MECHLORETHAMINE
1
injectable, 
topical

MEDROXYPROGESTERONE 
ACETATE
1
tablets, 
injectable

MEGESTROL ACETATE
1
tablets

MELPHALAN
1
tablets

MERCAPTOPURINE
1
tablets

MESNA
1
injectable

METHOTREXATE
1
injectable, 
tablets

MITOMYCIN
1
injectable
NOTE:  3rd line for bladder 
cancer indication
MITOXANTRONE
1
injectable

NANDROLONE DECANOATE
1
injectable

NILUTAMIDE
1
tablets
 - prostate cancer
PACLITAXEL
2
injectable
Ovarian Cancer 
 - first line treatment of 
ovarian cancer (irrespective 
of the stage of disease or 
amount of residual disease), 
fallopian tube carcinoma, 
primary peritoneal neoplasms 
and papillary serous and 
clear cell endometrial 
carcinomas



 - prescribing limited to 
written authorization by 
physicians recommended by 
the gynecology tumour 
program

2
injectable
Endometrial Cancer 
 - restricted for use in 
metastatic, advanced or 
recurrent endometrial cancer 
 - prescribing limited to 
written authorization by 
named physicians as 
recommended by the 
gynecology tumour program

2
injectable
Lung Cancer 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the lung tumour program

2
injectable
Adjuvant Chemotherapy in 
NSCLC 
- Vinorelbine (with 
Cisplatin) or Paclitaxel (with 
Carboplatin) for Adjuvant 
treatment of Non Small Cell 
Lung Cancer (NSCLC) stage 
IB-II 
- prescribing limited to 
written authorization by 
physicians recommended by 
the lung tumour program

2
injectable
Breast Cancer 
 - restricted to the treatment 
of metastatic breast cancer 
when no response to 
anthracycline (doxorubicin, 
epirubicin, or mitoxantrone) 
containing regimen. Relapse 
within 1 year after 
completion of adjuvant 
chemotherapy including an 
anthracycline. First 
assessment of efficacy after 2 
courses



 - only one taxane is to be 
administered to any one 
patient



- prescribing limited to 
written authorization by 
physicians recommended by 
the breast tumour program

2
injectable
Breast Cancer Adjuvant 
 - Doxorubicin/ 
Cyclophosphamide followed 
by Paclitaxel as an option for 
adjuvant therapy of Stage II, 
node positive or high risk 
node negative breast cancer 
 - prescribing limited to 
written authorization by 
named physicians as 
recommended by the breast 
tumour program

2
injectable
Testes 
 - 2nd line regimen for 
relapsed germ cell tumours 
of the testes

2
injectable
 - in combination 
chemotherapy for unknown 
primary metastatic 
adenocarcinoma 
 - prescribing limited to 
written authorization by 
named physicians as 
recommended by the breast 
and hematology tumour 
programs

3
injectable
Breast Cancer Adjuvant 
- Epirubicin/Cyclophos-
phamide followed by 
Paclitaxel for patients treated 
on the experimental arm of 
NCIC clinical trial MA 21



- prescribing limited to 
written authorization by a 
clinical trial principal 
investigator or 
co-investigator
PAMIDRONATE
1
injectable
- treatment of multiple 
myeloma
PREDNISOLONE SODIUM 
PHOSPHATE
1
liquid
- first line agent for pediatric 
patients under 7 years of age 
- 2nd-line agent for pediatric 
patients 7 years and older 
unable to tolerate prednisone 
tablets
PREDNISONE
1
tablets

PROCARBAZINE
1
capsules

RALTITREXED
2
injectable
- treatment of metastatic 
colorectal cancer 
 - prescribing limited to 
written authorization by 
physicians recommended by 
the GI tumour program
RITUXIMAB
2
injectable
- Rituximab plus 
chemotherapy for patients 
with follicular, mantle cell, 
and other CD20 positive 
indolent histology 
non-Hodgkin's lymphoma 
who have had no prior 
treatment with rituximab



 - relapsed or refractory, low 
grade or follicular, CD 20 
positive, B-cell, 
non-Hodgkin's  lymphoma



- prescribing limited to 
written authorization by 
physicians recommended by 
the lymphoma tumour 
program

2
injectable
- in combination with CHOP 
for aggressive histology 
B-cell CD20 positive 
non-Hodgkin's lymphoma 
(any stage or age) 
- prescribing limited to 
written authorization by 
named physicians as 
recommended by the 
hematology/lymphoma 
tumour program

2
injectable
 - for Post Transplant 
Lymphoproliferative 
Disorders (PTLD) 
- prescribing limited to 
written authorization by 
named physicians as 
recommended by the 
hematology tumour program
STREPTOZOCIN
1
injectable

TAMOXIFEN
1
tablets

TEMOZOLOMIDE
2
oral
 - first line treatment of 
recurrent glioblastoma 
multiforme and anaplastic 
astrocytoma 
- first line concurrent (with 
RT)/adjuvant treatment for 
malignant glioma 
- prescribing limited to 
written authorization by 
physicians recommended by 
the neuro oncology tumour 
program
TENIPOSIDE
1
injectable

THIOGUANINE
1
tablets

THIOTEPA
2
injectable

TOPOTECAN
2
injectable
Ovarian 
- 2nd line therapy of ovarian 
cancer, fallopian tube 
carcinoma and primary 
peritoneal neoplasms 
- prescribing limited to 
written authorization by 
physicians recommended by 
the gynecology tumour 
program



Pediatrics 
- restricted to the treatment 
of advanced stage 
neuroblastoma following 
POG/CCG Protocols 
- restricted to the treatment 
of intermediate risk 
rhabdomyosarcoma 
following POG/CCG 
protocols



- prescribing limited to 
written authorization by 
physicians recommended by 
the pediatric tumour program
TRASTUZUMAB
2
injectable
Metastatic Breast 
- restricted to the treatment 
of metastic breast cancer, 
HER 2 protein 
overexpression (+3) by IHC, 
or HER 2 amplification by 
FISH 
- prescribing limited to 
written authorization by 
physicians recommended by 
the breast tumour program
VALRUBICIN
2
injectable
 - for BCG refractory 
carcinoma in situ, defined as 
persistent disease after 2 
courses of BCG or 
intolerance (severe side 
effects, immunosuppression, 
etc.) to treatment with BCG
VINBLASTINE
1
injectable

VINCRISTINE
1
injectable

VINORELBINE
2
injectable
Lung Cancer 
- restricted to the treatment 
of advanced or metastatic 
non-small cell lung cancer 
with an ECOG score of 2 or 
better 
- prescribing limited to 
written authorization by 
physicians recommended by 
the lung tumour program

2
injectable
Metastatic Breast 
- first-line therapy for elderly 
patients (over 65 years of 
age) and 2nd or 3rd line 
therapy for metastatic breast 
cancer.  Assess response 
after 2 cycles 
- prescribing limited to 
written authorization by 
physicians recommended by 
the breast tumour program

2
injectable
Adjuvant Chemotherapy in 
NSCLC 
- Vinorelbine (with 
Cisplatin) or Paclitaxel (with 
Carboplatin) for Adjuvant 
treatment of Non Small Cell 
Lung Cancer (NSCLC) Stage 
IB/II 
- prescribing limited to 
written authorization by 
physicians recommended by 
the lung tumour program

THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 	
- 1027 -
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004

- 1026 -
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 205/2004	REAL ESTATE
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004

THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 207/2004	HEALTH INSURANCE PREMIUMS
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 208/200	PUBLIC SECTOR PENSION PLANS
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 210/2004	MOBILE HOME SITES TENANCIES
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 211/2004	RESIDENTIAL TENANCIES
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004

THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 212/2004	PERSONS WITH DEVELOPMENTAL  DISABILITIES  
	COMMUNITY GOVERNANCE
- 1046 -
    2/40924/A1/12795
- 23 -

THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 213/2004	ELECTION
- 1047 -
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 213/2004	ELECTION
- 1069 -



THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 213/2004	ELECTION
- 1073 -
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 213/2004	ELECTION
- 1071 -
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 214/2004	ELECTION
- 1074 -
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004

- 1075 -
   3/40927/A4/12796
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 215/2004	SENATORIAL SELECTION; ELECTION
- 1081 -



- 16 -

    1/40921/A4/12796
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 215/2005	SENATORIAL SELECTION; ELECTION
- 1091 -



- 69 -
- 71 -
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004

- 1093 -
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 216/2004	WILDLIFE
- 1096 -



THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004

THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004

- 1098 -
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 217/2004	INSURANCE
- 1116 -
THE ALBERTA GAZETTE, PART II, OCTOBER 15, 2004


AR 219/2004	CANCER PROGRAMS