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Alberta Regulation 218/2011
Animal Health Act
SWINE TRACEABILITY REGULATION
Filed: December 1, 2011
For information only:   Made by the Lieutenant Governor in Council (O.C. 457/2011) 
on December 1, 2011 pursuant to section 69 of the Animal Health Act. 
Table of Contents
	1	Definitions
	2	Application
	3	Application of swine identifier
	4	Manifests for shipment of swine
	5	Contents of manifests
	6	Shipper's duties
	7	Transporter's duties
	8	Receiver's duties
	9	Retention of manifests
	10	Submission of manifests
	11	Medicine withdrawal time
	12	False records or information
	13	Expiry
Definitions
1   In this Regulation,
	(a)	"agent" includes an assembler, a buyer, an agent described in 
the Bill of Lading and Conditions of Carriage Regulation 
(AR 313/2002) and a licensed livestock dealer and licensed 
livestock dealer's agent as defined in the Livestock 
Identification and Commerce Act;
	(b)	"approved swine identifier" means a form of swine 
identification that
	(i)	meets the requirements of the Health of Animals 
Regulations (Canada),
	(ii)	is assigned by the Alberta Pork Producers' 
Development Corporation to a producer for the 
producers premises pursuant to the Alberta Pork 
Producers' Commission Regulation (AR 285/96), or
	(iii)	is approved by the Minister for the purposes of this 
Regulation;
	(c)	"assembler" means a person who is required to be licensed to 
assemble swine for the purposes of the Alberta Pork 
Producers' Commission Regulation (AR 285/96);
	(d)	"buyer" means a buyer who is required to be licensed to buy 
swine for the purposes of the Alberta Pork Producers' 
Commission Regulation (AR 285/96);
	(e)	"manifest" means a record that meets the requirements of the 
Act and this Regulation;
	(f)	"premises" means a premises as defined in the Traceability 
Premises Identification Regulation (AR 200/2008);
	(g)	"premises identification number" means the premises 
identification number assigned by the Minister under the 
Traceability Premises Identification Regulation 
(AR 200/2008);
	(h)	"processor" means a person who slaughters swine and 
includes a buyer as a processor where the buyer purchases 
swine for a processor;
	(i)	"producer" means a producer as defined in the Alberta Pork 
Producers' Commission Regulation (AR 285/96);
	(j)	"receiver" means a person who receives swine and includes 
an assembler, buyer, processor, agent and consignee as 
described in the Bill of Lading and Conditions of Carriage 
Regulation (AR 313/2002);
	(k)	"shipper" means a person who ships swine and includes a 
producer, buyer, assembler, agent and a consignor as 
described in the Bill of Lading and Conditions of Carriage 
Regulation (AR 313/2002);
	(l)	"swine" means any member of the species Sus scrofa that is 
commonly known as a domestic pig or farmed wild boar;
	(m)	"transporter" means a person who transports swine and 
includes, without limitation, an agent, an assembler, a buyer 
and a producer;
	(n)	"withdrawal time" means withdrawal time as defined in the 
Act.
Application
2   This Regulation applies to all swine sent from one premises to 
another for slaughter.
Application of swine identifier
3   A producer must apply, to each head of swine, an approved swine 
identifier prior to transporting the swine or loading the swine for 
transport.
Manifests for shipment of swine
4(1)  Shippers, transporters and receivers must complete a manifest for
	(a)	each shipment in a vehicle that transports swine where swine 
are loaded and unloaded, and
	(b)	each transfer of swine from one premises to another 
premises.
(2)  Where a transporter stops at more than one premises to load swine 
onto a vehicle,
	(a)	a manifest must be completed for each group or lot of swine 
loaded onto the vehicle, and
	(b)	approved swine identifiers must be applied to each head of 
swine before each head of swine is loaded onto the vehicle.
Contents of manifests
5   A manifest required by this Regulation must include the following 
information: 
	(a)	for shippers,
	(i)	the shipper's name used for the purposes of the Alberta 
Pork Producers' Commission Regulation (AR 285/96), 
if the shipper is a producer, assembler or buyer;
	(ii)	the shipper's business name or operating name, or the 
agent's name if the business name or operating name is 
different than the shipper's name;
	(iii)	the premises identification number of the premises from 
which the swine are being transported;
	(iv)	the swine type;
	(v)	the approved swine identifier for the swine where the 
shipper is applying the approved swine identifier to the 
swine;
	(vi)	the number of swine leaving the premises;
	(vii)	the name of the receiver to whom the swine will be 
delivered, if known;
	(viii)	the premises identification number of the receiver to 
whom the swine will be delivered, if known;
	(xi)	if the shipper transports swine to the receiver, the 
information required to be completed by transporters in 
clause (c), except subclause (i);
	(x)	the name of the individual who completes the manifest 
on behalf of the shipper or the shipper's agent;
	(xi)	the signature of the individual who completes the 
manifest referred to in subclause (x);
	(b)	for transporters,
	(i)	the transporter's name;
	(ii)	the driver's name;
	(iii)	a 24-hour telephone number to contact the transporter;
	(iv)	the tractor or vehicle licence number;
	(v)	the trailer licence number if a trailer is attached to a 
vehicle or tractor;
	(vi)	the number of swine loaded onto the vehicle;
	(vii)	the day, month and year the swine are loaded for 
transport;
	(viii)	the time of day the swine leave the shipper's premises;
	(ix)	the name of the individual who completes the manifest 
on behalf the transporter;
	(x)	the signature of the individual who completes the 
manifest referred to in subclause (ix);
	(c)	for receivers,
	(i)	the receiver's name;
	(ii)	the receiver's name according to the processor's licence 
under the Meat Inspection Act (Canada) or the Meat 
Inspection Regulation (AR 42/2003) if the receiver is a 
processor and the receiver's name is different than the 
name provided under subclause (i);
	(iii)	the receiver's name according to the receiver's licence 
where the receiver is a buyer, assembler or processor 
pursuant to the Alberta Pork Producers' Commission 
Regulation (AR 285/96) if the receiver's name is 
different than the name required for the purposes of 
subclause (ii);
	(iv)	the premises identification number of the premises at 
which the receiver is receiving swine;
	(v)	the day, month and year the swine are received by the 
receiver;
	(vi)	the time of day the swine arrive at the receiver's 
premises;
	(vii)	the approved swine identifier where the receiver is 
applying the approved swine identifier to the swine;
	(viii)	the number of swine that are received by the receiver;
	(ix)	the name of the individual completing the manifest on 
behalf of the receiver;
	(x)	the signature of the individual who completes the 
manifest referred to in subclause (ix).
Shipper's duties
6   A shipper that is shipping swine must 
	(a)	complete the information described in section 5(a) on a 
manifest,
	(b)	provide the manifest to the transporter, and 
	(c)	retain a copy of the manifest. 
Transporter's duties
7   A transporter who is carrying swine must 
	(a)	complete the information described in section 5(b) on the 
manifest provided by the shipper before the swine leave the 
shipper's premises,
	(b)	leave a copy of the manifest with the shipper, 
	(c)	carry the manifest with the swine to the receiver identified on 
the manifest, 
	(d)	provide the manifest to the receiver on delivery of the swine, 
and 
	(e)	retain a copy of the manifest.
Receiver's duties
8(1)  A receiver receiving swine must 
	(a)	on receipt of the swine delivered by the transporter, complete 
the information described in section 5(c) on the manifest that 
is delivered with the swine, or if no manifest is delivered 
with the swine, record that information on a new manifest,
	(b)	provide a copy of the manifest to the transporter,
	(c)	submit the manifest within 48 hours of receiving the swine 
from the transporter in accordance with section 10, and
	(d)	retain a copy of the manifest to be made available to the 
shipper on request.
(2)  If the receiver receives swine that do not bear an approved swine 
identifier, the receiver must, before the swine are moved into a facility 
and commingled with other swine, apply an approved swine identifier 
to the swine and either 
	(a)	record the approved swine identifier on the manifest shipped 
with the swine, or
	(b)	record the approved swine identifier on a new manifest if a 
manifest has not been delivered with the swine.
(3)  If the receiver receives swine that bear an approved swine 
identifier but there is no manifest delivered with the swine, the receiver 
must record the approved swine identifier on a new manifest.
Retention of manifests
9(1)  Shippers and receivers must keep manifests for a period of 5 
years.
(2)  Transporters must keep manifests for a period of one year.
(3)  Shippers, transporters and receivers must, on the direction of the 
Minister, provide manifests or records of manifests to the Minister 
upon request.
Submission of manifests
10   Receivers must comply with this Regulation by sending 
manifests, by a means acceptable to the Minister, to the Livestock 
Identification Services Ltd. for entry into the database created for the 
purposes of this Regulation on behalf of the Alberta Pork Producers' 
Development Corporation.
Medicine withdrawal time
11   No person shall ship swine for slaughter unless the medicine 
withdrawal time has passed for each head of swine included in the 
shipment.
False records or information
12   No person shall create false records or provide false information 
for the purposes of this Regulation.
Expiry
13   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 August 30, 2016.


--------------------------------
Alberta Regulation 219/2011
Alberta Capital Finance Authority Act
ALBERTA CAPITAL FINANCE AUTHORITY AMENDMENT REGULATION
Filed: December 1, 2011
For information only:   Made by the Lieutenant Governor in Council (O.C. 482/2011) 
on December 1, 2011 pursuant to section 35 of the Alberta Capital Finance Authority 
Act. 
1   The Alberta Capital Finance Authority Regulation 
(AR 258/2006) is amended by this Regulation.

2   Section 1.1 is amended by striking out "$11 000 000 000" 
and substituting "$13 000 000 000".


--------------------------------
Alberta Regulation 220/2011
Judicature Act
JUSTICES OF THE PEACE COMPENSATION COMMISSION 
ESTABLISHMENT AMENDMENT REGULATION
Filed: December 1, 2011
For information only:   Made by the Lieutenant Governor in Council (O.C. 489/2011) 
on December 1, 2011 pursuant to section 42 of the Judicature Act. 
1   The Justices of the Peace Compensation Commission 
Establishment Regulation (AR 74/2009) is amended by this 
Regulation.

2   Section 4(2) is amended by striking out "January" and 
substituting "July".


--------------------------------
Alberta Regulation 221/2011
Municipal Government Act
WELL DRILLING EQUIPMENT TAX RATE AMENDMENT REGULATION
Filed: December 7, 2011
For information only:   Made by the Minister of Municipal Affairs (M.O. L:213/11) 
on November 30, 2011 pursuant to section 390 of the Municipal Government Act. 
1   The Well Drilling Equipment Tax Rate Regulation 
(AR 221/2010) is amended by this Regulation.

2   Section 1 is amended by striking out "in 2011" and 
substituting "in 2011 and 2012".

3   Section 3 is amended by striking out "December 31, 2011" 
and substituting "December 31, 2012".



Alberta Regulation 222/2011
Marketing of Agricultural Products Act
ALBERTA ELK COMMISSION AMENDMENT REGULATION
Filed: December 9, 2011
For information only:   Made by the Alberta Elk Commission on October 7, 2011 and 
approved by  the Agricultural Products Marketing Council on November 15, 2011 
pursuant to section 26 of the Marketing of Agricultural Products Act. 
1   The Alberta Elk Commission Regulation (AR 256/2002) is 
amended by this Regulation.

2   Section 3(3) is amended by striking out "in each following 
year" and substituting "of each year following the year of 
assessment under subsection (1)".

3   Section 4(1) is repealed and the following is substituted:
Confirmation or variance of service charges
4(1)   At each annual Commission meeting, the Commission is to 
submit for the approval of the eligible producers the following:
	(a)	with respect to the service charges, the amount of
	(i)	the base service charge, and
	(ii)	the product service charge,
		that is to be charged for that year;
	(b)	the products and services, if any, in respect of which the 
product service charge is applicable for that year;
	(c)	the manner of assessing the base service charge for that year.

4   Section 6(3) is amended
	(a)	by striking out "fiscal year" and substituting "year";
	(b)	by striking out "calendar year" and substituting "year". 



Alberta Regulation 223/2011
Municipal Government Act
CAPITAL REGION ASSESSMENT SERVICES COMMISSION 
AMENDMENT REGULATION
Filed: December 15, 2011
For information only:   Made by the Lieutenant Governor in Council (O.C. 503/2011) 
on December 15, 2011 pursuant to section 602.02 of the Municipal Government Act. 
1   The Capital Region Assessment Services Commission 
Regulation (AR 77/96) is amended by this Regulation.

2   The Schedule is amended by renumbering clause (b.1) 
as (b.2) and by adding the following after clause (b):
	(b.1)	Town of Bon Accord


--------------------------------
Alberta Regulation 224/2011
Public Health Act
QUALIFICATIONS OF EXECUTIVE OFFICERS  
AMENDMENT REGULATION
Filed: December 15, 2011
For information only:   Made by the Lieutenant Governor in Council (O.C. 507/2011) 
on December 15, 2011 pursuant to section 66 of the Public Health Act. 
1   The Qualifications of Executive Officers Regulation 
(AR 51/99) is amended by this Regulation.

2   Section 4 is amended by striking out "January 31, 2012" 
and substituting "January 31, 2019".



Alberta Regulation 225/2011
Tobacco Tax Act
TOBACCO TAX AMENDMENT REGULATION
Filed: December 15, 2011
For information only:   Made by the Lieutenant Governor in Council (O.C. 513/2011) 
on December 15, 2011 pursuant to section 48 of the Tobacco Tax Act. 
1   The Tobacco Tax Regulation (AR 273/83) is amended by 
this Regulation.

2   Section 1 is amended
	(a)	in subsection (1)


	(i)	by adding the following after clause (a):
	(a.1)	"Alberta stamp" means an excise stamp, as defined 
in the Excise Act, 2001 (Canada), that is approved 
by the Minister in agreement with the Canada 
Revenue Agency to mark packages of tobacco 
products sold in Alberta to a consumer other than a 
person referred to in section 13(2.1);
	(ii)	in clause (c) by striking out ", tobacco sticks or 
fine cut tobacco" and substituting "or tobacco 
sticks";
	(iii)	by repealing clause (d) and substituting the 
following:
	(d)	"case" means a container for the shipping of 
packages or cartons;
	(b)	in subsection (2)
	(i)	in clause (i) by striking out "into the tobacco 
product";
	(ii)	by adding the following after clause (j):
	(j.1)	"marking permit holder" means a person who 
holds a permit issued under section 14.1;
	(c)	by adding the following after subsection (3):
(4)  For the purposes of sections 14.1, 14.2 and 14.4, tobacco 
products do not include cigarettes contained in a 200-cigarette 
package.

3   Section 12.3(3)(d) is amended by striking out "cigarettes, 
tobacco sticks, fine cut tobacco, cigars or".

4   Section 13 is amended
	(a)	by repealing subsection (1.1) and substituting the 
following:
(1.1)  In the case of a tax-exempt sale by an exempt sale 
retailer, only black stock may be sold.
	(b)	by repealing subsection (2.01) and substituting the 
following
(2.01)  In the case of a tax-exempt sale by a duty free shop, 
only black stock may be sold.

5   Section 14.1(4) is repealed and the following is 
substituted:
(4)  A marking permit holder shall obtain, in accordance with 
the procedures set out in the Excise Act, 2001 (Canada), 
Alberta stamps for marking packages of tobacco products.

6   Section 14.2 is amended by striking out "cigarettes, tobacco 
sticks or fine cut tobacco" and substituting "tobacco products".

7   Section 14.4 is repealed and the following is substituted:
Marking of tobacco products
14.4   For the purposes of sections 14.2 and 14.3, each package of a 
tobacco product that is manufactured in Canada, or that is imported 
into Canada for sale in Alberta, must be marked by a marking permit 
holder with one of the following Alberta stamps:
	(a)	cigarettes - 20 units;
	(b)	cigarettes - 25 units;
	(c)	tobacco - 50 grams;
	(d)	tobacco - 100 grams;
	(e)	tobacco - 150 grams;
	(f)	tobacco - 200 grams;
	(g)	tobacco - 250 grams;
	(h)	tobacco - 400 grams.
Discrepancy between package weight and actual weight
14.41   Where the actual weight of tobacco in a package is different 
from the weight of tobacco indicated by the Alberta stamp, the actual 
weight of tobacco in the package must be used in the computation of 
tax payable under section 3 of the Act.
Transitionals
14.42(1)   In this section, "former regulation" means the Tobacco 
Tax Regulation (AR 273/83) as it read immediately before the 
coming into force of this section.
(2)  Despite anything to the contrary in this Regulation, from April 1, 
2012 to September 30, 2012, tobacco products may be marked
	(a)	in accordance with the former regulation,
	(b)	in accordance with this Regulation, or
	(c)	in accordance with both the former regulation and this 
Regulation.
(3)  If tobacco products are marked in the manner described in 
subsection (2)(a), the rules applicable under the former regulation 
apply in respect of the tobacco products.
(4)  If tobacco products are marked in the manner described in 
subsection (2)(b), the rules applicable under this Regulation apply in 
respect of the tobacco products.
(5)  If tobacco products are marked in the manner described in 
subsection (2)(c),
	(a)	the rules applicable under the former regulation apply in 
respect of the tobacco products marked in accordance with 
the former regulation, and
	(b)	the rules applicable under this Regulation apply in respect of 
the tobacco products marked in accordance with this 
Regulation.

8   Section 14.8(1) is repealed and the following is 
substituted:
(1)  A manufacturer shall not store in Alberta packages, cartons or 
cases that bear the mark of another jurisdiction, except a mark-point.

9   This Regulation comes into force on April 1, 2012.


--------------------------------
Alberta Regulation 226/2011
Election Act
FEES AND EXPENSES AMENDMENT REGULATION
Filed: December 15, 2011
For information only:   Made by the Lieutenant Governor in Council (O.C. 521/2011) 
on December 15, 2011 pursuant to section 207 of the Election Act. 
1   The Fees and Expenses Regulation (AR 173/2004) is 
amended by this Regulation.

2   Section 1 is amended
	(a)	in clause (a) by striking out "$130" and substituting 
"$150";
	(b)	in clause (d) by striking out "$175" and substituting 
"$200";
	(c)	in clause (f) by striking out "$1525" and substituting 
"$1750";
	(d)	by repealing clause (g) and substituting the 
following:
	(g)	a fee of $5750 if a writ of election is issued and a poll is 
held, including training of election staff, the conduct of 
the official count and the post-election update of the 
register of electors;
	(e)	in clause (h) by striking out "$0.17" and substituting 
"$0.20";
	(f)	in clause (j) by striking out "$22" and substituting 
"$25".

3   Section 3 is repealed and the following is substituted:
Election clerk fees
3   An election clerk may be paid the following:
	(a)	a fee of $1455, where a writ of election is issued and no poll 
is held;
	(b)	a fee of $3850 if a writ of election is issued and a poll is held, 
including training of election staff, the conduct of the official 
count and the post-election update of the register of electors;
	(c)	a fee of $0.17 per name included in the list of electors on 
polling day;
	(d)	a fee of $200 for attending a class of instruction called by the 
Chief Electoral Officer;
	(e)	when required to travel on official business, the rates 
prescribed in the Public Service Subsistence, Travel and 
Moving Expenses Regulation made under the Public Service 
Act;
	(f)	a supplemental fee of $19 for every 100 km, or portion 
thereof, travelled in excess of the first 100 km of travel 
during an election.

4   Section 4 is amended
	(a)	in clause (a) by striking out "$2800" and substituting 
"$3220";
	(b)	in clause (d) by striking out "$150" and substituting 
"$175".

5   Section 5 is repealed and the following is substituted:
Supervisory deputy returning officer fees
5   A supervisory deputy returning officer may be paid the 
following:
	(a)	a basic fee of $290 for duties performed on polling day or on 
each advance polling day;
	(b)	a fee of $60 for attending a class of instruction;
	(c)	when required to travel on official business, the rates 
prescribed in the Public Service Subsistence, Travel and 
Moving Expenses Regulation made under the Public Service 
Act.

6   Section 6 is repealed and the following is substituted:
Registration officer fees
6   A registration officer may be paid the following:
	(a)	a basic fee of $230 for duties performed on polling day or on 
each advance polling day;
	(b)	a fee of $60 for attending a class of instruction;
	(c)	when required to travel on official business, the rates 
prescribed in the Public Service Subsistence, Travel and 
Moving Expenses Regulation made under the Public Service 
Act.

7   Section 7 is repealed and the following is substituted:
Deputy returning officer fees
7   A deputy returning officer may be paid the following:
	(a)	a basic fee of $240 for duties performed on polling day or on 
each advance polling day;
	(b)	a fee of $60 for attending a class of instruction;
	(c)	when required to travel on official business, the rates 
prescribed in the Public Service Subsistence, Travel and 
Moving Expenses Regulation made under the Public Service 
Act.

8   Section 8(a) is repealed and the following is substituted:
	(a)	a basic fee of $200 for duties performed on polling day or on 
each advance polling day;

9   Section 10(1)(a) is repealed and the following is 
substituted:
	(a)	a maximum of $180 per day for the rental of a building 
where one poll is held and $90 per day for each additional 
poll held in the same building or part of the building, which 
includes the cost of utilities, janitorial services and the supply 
of all necessary furniture;



Alberta Regulation 227/2011
Judicature Act
ALBERTA RULES OF COURT (MISCELLANEOUS FORMS) 
AMENDMENT REGULATION
Filed: December 15, 2011
For information only:   Made by the Lieutenant Governor in Council (O.C. 522/2011) 
on December 15, 2011 pursuant to section 28.1 of the Judicature Act. 
1(1)   The Adult Adoption Regulation (AR 246/98) is 
amended by this section.
(2)  The Schedule is repealed and the following is 
substituted:


Schedule 
 
Form 1 
Application for Adoption Order
	Adult Adoption Act
	Clerk's stamp:
COURT FILE NUMBER
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE	
APPLICANT(S)	
DOCUMENT		APPLICATION FOR
		ADOPTION ORDER
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
	
PERSON TO BE ADOPTED:	(full name of person to be 
	adopted, as on birth document)
DATE OF BIRTH:  	_______________
BIRTH REGISTRATION NUMBER:	_______________
	
	 1 				Application
		By making this application, I/we state:
	?	that I am/we are adults who want to adopt this person.
	?	that to support my/our application, I/we have enclosed 
my/our affidavit(s) and the other information required 
by the Adult Adoption Act.
	
	 2 				Signature(s)
   (signature of applicant)    	  year / month / day  
   (signature of applicant)    	  year / month / day  
NOTICE TO:                                                                         
An application for an order for adoption of    (full name of 
person to be adopted, as on birth document)    will be made to 
the Court as shown below:
	Court Date 	___________________
	Time 	___________________
	Where 	___________________
	Before Whom 	___________________
WARNING
Pursuant to the Adult Adoption Act and the Alberta Rules of 
Court, if you do not come to Court on the date and at the time 
shown above either in person or by your lawyer, the Court may 
make an adoption order in your absence.
Form 2 
Affidavit of Applicant
	Adult Adoption Act
	Clerk's stamp:
COURT FILE NUMBER
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE	
APPLICANT(S)	
DOCUMENT		AFFIDAVIT OF
		APPLICANT    
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
	
PERSON TO BE ADOPTED:	(full name of person to be 
	adopted, as on birth document)
DATE OF BIRTH:  	_______________
BIRTH REGISTRATION NUMBER:	_______________
	
I,    (legal name of applicant)    , of    (address)   , in the Province of 
Alberta, swear/affirm that:
1.	I am applying for an adoption order: (check one of the 
following)
	?	as an individual.
	?	jointly with my spouse, and a certified copy of our 
marriage certificate is attached.
2.	I am            years old.
3.	I have known    (name of person to be adopted)    for the past 
           years.
	The nature of our relationship is: 	.
4.	The reason I wish to adopt    (name of person to be 
adopted)    is 	.
5.	Sealing the court file:  (check one of the following)
	?	I am applying to have the court file sealed.  My reason 
for wanting the court file sealed is__________________.
	?	I am not applying to have the court file sealed.
Sworn/Affirmed before me	) 
on  __________________, 20____,	) 
at                                        , Alberta	)	                                     
_________________________________     )   Signature of Applicant 
(Notary Public / Commissioner for Oaths	) 
in and for the Province of Alberta)	)
Form 3 
Affidavit of Person to be Adopted
	Adult Adoption Act
	Clerk's stamp:
COURT FILE NUMBER
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE	
APPLICANT(S)	
DOCUMENT		AFFIDAVIT OF PERSON
		TO BE ADOPTED           
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
	
PERSON TO BE ADOPTED:	(full name of person to be 
	adopted, as on birth document)
DATE OF BIRTH:  	_______________
BIRTH REGISTRATION NUMBER:	_______________
	
I,    (legal name of applicant)   , of    (address)   , in the Province of 
Alberta, swear/affirm that:
1.	I am              years old.  A certified copy of my birth 
document is attached.
2.	I consent to my adoption by    (name(s) of applicant(s))   .  
I understand the nature and effect of an adoption order.
3.	Change of name: (check one of the following)
	?	A certified copy of my change of name certificate is 
attached.
	?	I have not had a change of name.
4.	Citizenship/residency: (check one of the following)
	?	I am a Canadian citizen.
	?	I have been lawfully admitted to Canada for permanent 
residence and notarized copies of my immigration 
documents are attached.
5.	The reason I want to be adopted by    (name(s) of 
applicant(s))    is 	.
6.	Court hearing:  (check one of the following)
	?	I wish to appear in person before the judge considering 
this adoption application.
	?	I do not wish to appear in person before the judge 
considering this adoption application.
7.	Sealing the court file:  (check one of the following)
	?	I am applying to have the court file sealed.  My reason 
for wanting the court file sealed is 	.
	?	I am not applying to have the court file sealed.
Sworn/Affirmed before me	) 
on  __________________, 20____,	) 
at                                        , Alberta	)	                                
_________________________________     )   Signature of Person  
(Notary Public / Commissioner for Oaths     	)   to be Adopted 
in and for the Province of Alberta)	)

Form 4 
Adoption Order
	Adult Adoption Act
	Clerk's stamp:
COURT FILE NUMBER
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE	
APPLICANT(S)	
DOCUMENT		ADOPTION ORDER
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
	
DATE ON WHICH ORDER WAS PRONOUNCED: 	
NAME OF JUDGE WHO MADE THIS ORDER: 	
LOCATION OF HEARING: ______________, Alberta
	
THIS COURT having received the application of    (name(s) of 
applicant(s))    under the Adult Adoption Act for an adoption order in 
respect of:
   (full name of person to be adopted, as on birth document),   
born    (date-yyyy/mm/dd)   
Birth Registration Number           .
AND THIS COURT having reviewed the evidence presented, and 
being satisfied that the reasons for the adoption are valid and 
acceptable and that it is not contrary to the public interest to grant this 
application;
IT IS ORDERED THAT: 
1.	The application is granted as requested and the adoption is 
effective from and after the date of this Order.
2.	(Other applicable terms)
	_______________________________
	Justice of the Court of Queen's Bench

2(1)  The Builders' Lien Forms Regulation (AR 51/2002) is 
amended by this section.
(2)  The Schedule is amended 
	(a)	by repealing Form 6 and substituting the following:
Form 6 
(Section 43)
	Clerk's stamp:
COURT FILE NUMBER
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE
PLAINTIFF(S)
DEFENDANT(S)	
DOCUMENT		CERTIFICATE OF 
		LIS PENDENS     
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
To:  Registrar of Land Titles (or the Minister of Energy)
This is to certify that proceedings have been taken in court to enforce a 
certain lien registered by                      against                                 (here 
describe lands), which lien was registered pursuant to the Builders' 
Lien Act in the Land Titles Office (or with the Minister of Energy) on 
            day of           ,            as No.        .
Dated at                        this                 day of                           ,         .
			   (Court Clerk)   
	(b)	by repealing Form 8 and substituting the following:
Form 8 
(Section 52)
	Clerk's stamp:
COURT FILE NUMBER
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE	
PLAINTIFF(S)	
DEFENDANT(S)	
DOCUMENT		NOTICE TO   
		PROVE LIEN
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
To:  (Name of lienholder)  
Take notice that the undersigned hereby requires that you prove your 
lien registered pursuant to the Builders' Lien Act on the            day of 
                        ,       in the Land Titles Office (or with the Minister of 
Energy) as No.       with respect to the following land:
(set out concise legal description)
And further take notice that unless within 15 days from the date of 
service of this Notice upon you, you file in the office of the court clerk 
at                        , Alberta, an affidavit giving detailed particulars of 
your lien pursuant to section 52 of the Builders' Lien Act, you will lose 
your lien.
Dated at                            this                      day of                 ,          .
	                (Name of party giving notice)     

3(1)  The Court Rules and Forms Regulation (AR 39/2002) is 
amended by this section.
(2)  The Schedule is amended 
	(a)	by repealing Forms 31 to 34 and substituting the 
following:
Form 31 
Application for Adoption Order 
 
Child, Youth and Family Enhancement Act 
 (section 62)
COURT FILE NUMBER	Clerk's stamp:
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE	
APPLICANT(S)	
DOCUMENT		APPLICATION FOR
		ADOPTION ORDER
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
	
CHILD TO BE ADOPTED:	(full name of child to be 
	adopted, as on birth document)
DATE OF BIRTH:  	_______________
BIRTH REGISTRATION NUMBER:	_______________
	
1   Application
By making this application, I (we) state:
	?	that I (we) am (are) adults who want to adopt this child.
	?	that to support my (our) application, I (we) have 
enclosed my (our) affidavit(s) and the other information 
required by section 63 of the Child, Youth and Family 
Enhancement Act.
I (We) respectfully request that the Court order the child's adoption by 
me (us) and that the child be given the name 	.
2   Signatures
   (signature of applicant)    	   (print name)    
	    (date-yyyy/mm/dd)   
   (signature of applicant)    	   (print name)    
	    (date-yyyy/mm/dd)   
Form 32 
Notice of Objection to Adoption 
 
Child, Youth and Family Enhancement Act 
(section 64)
COURT FILE NUMBER	Clerk's stamp:
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE	
APPLICANT(S)	
DOCUMENT		NOTICE OF OBJECTION
		TO ADOPTION
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
	
CHILD TO BE ADOPTED:	(full name of child to be 
	adopted, as on birth document)
DATE OF BIRTH:  	_______________
BIRTH REGISTRATION NUMBER:	_______________
	
1	I was served with a copy of an application for adoption of 
this child on    (date-yyyy/mm/dd)   .
2	I object to the application being considered without a Court 
hearing.
3	I understand that if I file this Notice of Objection to Adoption 
with the court clerk, a hearing will be held.
4	I understand the applicant must serve a Notice of Adoption 
Hearing on me and on all persons who were served with a 
copy of the application, unless a person requested not to be 
served with a Notice of Adoption Hearing.
5	I understand that the application for an adoption order will 
proceed without a hearing if no Notice of Objection to 
Adoption is filed, unless the judge orders a hearing.
Dated at    (location)   , on    (date-yyyy/mm/dd)   .
  (signature of person objecting)    	        (print name )         
   (mailing address)   	   (phone number)   
	   (fax number, if applicable)   
If you object to the application being heard in the absence of the 
applicant or anyone else who was served with a copy of the 
application, you must file this Notice of Objection to Adoption with 
the court clerk within 10 days of being served. 
Form 33 
Notice of Adoption Hearing 
 
Child, Youth and Family Enhancement Act 
 (section 64)
COURT FILE NUMBER	Clerk's stamp:
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE	
APPLICANT(S)	
DOCUMENT		NOTICE OF                
		ADOPTION HEARING
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
	
CHILD TO BE ADOPTED:	(full name of child to be 
	adopted, as on birth document)
DATE OF BIRTH:  	_______________
BIRTH REGISTRATION NUMBER:	_______________
	

NOTICE
I (We) will be applying to the Court for an adoption order under 
the Child, Youth and Family Enhancement Act regarding this 
child.
The application for an adoption order will be made to the Court 
as shown below:\
	Court Date 	(date)                                           
	Time 	(time)                                           
	Where 	(address)                                      
	Before Whom 	Presiding Justice in Chambers
WARNING
If you object to this application, you must attend the hearing. If 
you do not come to Court on the date and at the time shown 
above either in person or by your lawyer, the Court may make 
an Order of Adoption in your absence.
   (signature of applicant)    	   (print name)    
	    (date-yyyy/mm/dd)   
   (signature of applicant)    	   (print name)    
	    (date-yyyy/mm/dd)   
Form 34 
Adoption Order 
 
Child, Youth and Family Enhancement Act 
(sections 70 and 72)
COURT FILE NUMBER	Clerk's Stamp:
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE	
APPLICANT(S)	
DOCUMENT		ADOPTION ORDER
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
	
DATE ON WHICH ORDER WAS PRONOUNCED: 	
NAME OF JUDGE WHO MADE THIS ORDER: 	
LOCATION OF HEARING: ______________, Alberta
	
THIS COURT having received the application of    (name(s) of 
applicant(s))    under the Child, Youth and Family Enhancement Act 
for an adoption order in respect of the child:
(full name of child to be adopted, as on birth document),
born    (date-yyyy/mm/dd)   
Birth Registration Number           .
AND THIS COURT having heard the evidence presented, and being 
satisfied that:
	(a)	the applicant(s) is (are) capable of assuming and willing to 
assume the responsibility of a parent toward the child, and
	(b)	it is in the best interests of the child that the child be adopted 
by the applicant(s).
IT IS ORDERED THAT: 
1.	The application of    (name(s) of applicant(s))    is granted 
and the child is, from and after the date of this order, the 
adopted child of the applicant(s) and the child shall hereafter 
bear the given name(s) and surname of    (full name of 
child)   .
2.	(Other applicable terms).
	_______________________________ 
	Justice of the Court of Queen's Bench
	(b)	by repealing Forms 40 and 41 and substituting the 
following:
Form 40 
Notice of Appeal - Provincial Court Order 
 
Child, Youth and Family Enhancement Act 
(section 114)
COURT FILE NUMBER	Clerk's Stamp:
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE                                            	
APPELLANT(S)                                                   	
RESPONDENT(S)                                                	
DOCUMENT		Notice of Appeal -       
		Provincial Court Order
	Child, Youth and Family Enhancement Act
REGARDING THE CHILD(REN)  	 
	                                                 
PROVINCIAL COURT ORDER  
MADE AT	[City or Town], Alberta
ADDRESS FOR SERVICE AND 	[ADDRESS]
CONTACT INFORMATION OF 	Ph. [Phone#]
PARTY FILING THIS DOCUMENT	Fx. [Fax#]
NOTICE
The appellant has filed an appeal in this matter. You are a 
respondent. You have the right to state your side of this matter 
before the court.
To do so, you must attend at the initial court appearance shown 
below:
	Court Date 	(date)                                           
	Time 	(time)                                           
	Where 	(address)                                      
	Before Whom 	Presiding Justice in Chambers
At the initial court appearance, the court will set a date for the 
appeal to be heard, provide further direction regarding the 
manner in which the appeal will be heard and address any other 
preliminary matters the parties may wish to raise with the court 
in advance of the appeal hearing, including any evidence the 
court may permit or require to be given.
Go to the end of this document to see what else you can do and 
when you must do it.
Nature of appeal to be put before the court:
1.	The appellant appeals to the Court of Queen's Bench of 
Alberta the decision of the Provincial Court Judge    (name of 
judge, if known)    sitting at    (city/town)   , Alberta on 
   (date of Provincial Court hearing)   , 20   (year)   .  The 
Provincial Court Judge ordered    (nature of the order being 
appealed)   .
Grounds on which the appeal is based:
2.			
			
			
Remedy sought:
3.				
			
4.	In addition to the appeal of the decision of the Provincial 
Court Judge, the appellant will also request an order for the 
following other relief:
	?	a stay of execution of the order appealed pending the 
hearing of the appeal;
	?	permission to introduce new evidence at the hearing of 
the appeal;
	?	other:  	.
Evidence to be used in support of this appeal:
5.	The record of the evidence taken, including the transcript, 
and all other material in the possession of the Provincial 
Court that pertains to the matter being appealed.
6.	Any further evidence that the court may require or permit to 
be given, including:
			
			
			.
WARNING
If you do not come to court either in person or by your lawyer, 
the court may give the appellant(s) what they want in your 
absence. You will be bound by any order that the court makes, 
or another order might be given or other proceedings taken 
which the appellant(s) is/are entitled to without any further 
notice of them to you. If you want to state your side of this 
matter before the court, you or your lawyer must attend in court 
on the date and time shown above. If you intend to ask the court 
for permission to introduce new evidence when the appeal is 
heard or considered, you must give reasonable notice of your 
intention to the appellant.
Form 41 
Notice of Appeal - Appeal Panel Decision 
 
Child, Youth and Family Enhancement Act 
(section 120.1)
COURT FILE NUMBER	Clerk's Stamp:
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE                                            	
APPELLANT(S)                                                   	
RESPONDENT(S)                                                	
DOCUMENT		Notice of Appeal -       
		Appeal Panel Decision
	Child, Youth and Family Enhancement Act
ADDRESS FOR SERVICE AND 	[ADDRESS]
CONTACT INFORMATION OF 	Ph. [Phone#]
PARTY FILING THIS DOCUMENT	Fx. [Fax#]
NOTICE TO THE RESPONDENT(S)
The appellant has filed an appeal in this matter. You are a 
respondent. You have the right to state your side of this matter 
before the court. 
To do so, you must attend at the initial court appearance shown 
below:
	Court Date 	(date)                                           
	Time 	(time)                                           
	Where 	(address)                                      
	Before Whom 	Presiding Justice in Chambers
At the initial court appearance, the court will set a date for the 
appeal to be heard, provide further direction regarding the 
manner in which the appeal will be heard and address any other 
preliminary matters that the parties may wish to raise with the 
court in advance of the appeal hearing, including any evidence 
the court may permit or require to be given.
Go to the end of this document to see what else you can do and 
when you must do it.
Nature of appeal to be put before the court:
1.	The appellant appeals to the Court of Queen's Bench of 
Alberta the decision of the Appeal Panel made under the 
Child, Youth and Family Enhancement Act on    (date of 
decision)   , 20   (year)   .  The Appeal Panel decided that 
   (nature of the decision being appealed)   .
Grounds on which the appeal is based:
2.			
			
			
Remedy sought:
3.			
			
			
4.	In addition to the appeal of the decision of the Appeal Panel, 
the appellant will also request an order for the following 
other relief:
	?	a stay of execution of the decision appealed pending the 
hearing of the appeal;
	?	permission to introduce new evidence at the hearing of 
the appeal;
	?	other:  	.
Evidence to be used in support of this appeal:
5.	The record of the evidence before the Appeal Panel, 
including the transcript, if any.
6.	Any further evidence that the court may require or permit to 
be given, including:
			
			
			.
WARNING
If you do not come to court either in person or by your lawyer, 
the court may give the appellant(s) what they want in your 
absence. You will be bound by any order that the court makes, 
or another order might be given or other proceedings taken that 
the appellant(s) is/are entitled to without any further notice of 
them to you. If you want to state your side of this matter before 
the court, you or your lawyer must attend in court on the date 
and time shown above. If you intend to ask the court for 
permission to introduce new evidence when the appeal is heard 
or considered, you must give reasonable notice of your intention 
to the appellant.

4(1)  The Civil Enforcement Regulation (AR 276/95) is 
amended by this section.
(2)  Schedule 4 is amended in Forms 13 and 14 by striking 
out "In accordance with the Alberta Rules of Court" and substituting "In 
accordance with section 35.10 of the Civil Enforcement Regulation 
(AR 276/95)".

5(1)   The Forms Regulation (AR 480/81) is amended by this 
section.
(2)  Form 30 is repealed and the following is substituted:
Form 30 
 
Land Titles Act 
(Sections 123, 138 and 148)
COURT FILE NUMBER	Clerk's Stamp:
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE	
PLAINTIFF(S)	
DEFENDANT(S)	
DOCUMENT		CERTIFICATE OF 
		LIS PENDENS     
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
This is to certify that in this action a claim has been made to 
enforce an interest in land or some title or interest in land is called 
into question, as follows: (here give particulars of the claim, and 
include registration particulars of any registered instrument or 
caveat affected by the action) in respect of the following land: 
(here describe land).
Dated at                             , Alberta, on             (date)           .
			                              
		(Court Clerk)
(3)  Form 34 is repealed and the following is substituted:
Form 34 
 
Land Titles Act 
(Section 185)
COURT FILE NUMBER	Clerk's Stamp:
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE	
APPLICANT       Registrar of Land Titles	
DOCUMENT		REFERENCE UNDER    
		THE LAND TITLES ACT
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
Reference to the Court under section 185 of the Land Titles 
Act.
Basis for the reference to be put before the Court:
1.	This reference relates to the registration of transfer (or as the 
case may be) A.B. to C.D.
2.	The Registrar under section 185 of the Land Titles Act hereby 
refers the following matter to the judge:
(here state briefly the difficulty that has arisen).
3.	The parties interested, so far as the Registrar knows or has 
been informed, are:    (here give the names)   .
 	              (Signature)    
(Official seal)	Registrar   

6(1)  The Irrigation Forms Regulation (AR 81/2000) is 
amended by this section.
(2)  Form 17A is repealed and the following is substituted:
Form 17A 
Irrigation Districts Act 
(Section 138/139) 
 
Application for Confirmation 
of Enforcement
COURT FILE NUMBER	Clerk's Stamp:
COURT OF QUEEN'S BENCH OF ALBERTA
JUDICIAL CENTRE	
APPLICANT    The _______ Irrigation District	
RESPONDENT(S)
DOCUMENT		ORIGINATING APPLICATION - 
		CONFIRMATION OF (year)        
		ENFORCEMENT RETURN        
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
NOTICE TO THE RESPONDENT(S)
This application is made against you.  You are a respondent.  
You have the right to state your side of this matter before the 
Court.
	Date 	________________________
	Time 	________________________
	Where 	________________________
	Before 	Presiding Justice in Chambers
On the date of the hearing, the Court may hear the Applicant 
and any objecting parties, or set a date for a formal hearing. 
Go to the end of this document to see what you can do and when 
you must do it.
Basis for this claim:
1.	The Respondent(s) appear(s) by the records of the Applicant 
and the South Alberta Land Registration District to have an 
interest in the following described parcels of land:
(describe land as on abstracts of title on record at 
the Land Titles Office and the assessment roll)
2.	The parcels or land are shown in the Applicant's    (year)    
Enforcement Return by reason of the fact that the amounts 
shown in the billing notice as payable to the Applicant in the 
amount of $________ in respect to the said parcels of land 
have not been paid in accordance with section 137(2) of the 
Irrigation Districts Act.
Remedy sought:
3.	An Order confirming the    (year)    Enforcement Return of 
the Applicant.
4.	_______________________________________________
Affidavit or other evidence to be used in support of this 
application:
5.	_______________________________________________
Applicable Acts and regulations:
6.	Irrigation Districts Act (sections 138 and 139).
If you do not pay the above-noted amount seven (7) days prior 
to the date set for the Court hearing, further costs will be 
assessed and registered against the said lands.
WARNING
If you do not come to Court either in person or by your lawyer, 
the Court may give the applicant what it wants in your absence, 
including confirmation of the Enforcement Return insofar as it 
relates to the above-described parcels of land, and the Court 
may fix costs of this application. You will be bound by any 
order that the Court makes.
If you want to take part in this application, you or your lawyer 
must attend in Court on the date and at the time shown at the 
beginning of this form.  If you intend to rely on an affidavit or 
other evidence when the application is heard or considered, you 
must reply by giving reasonable notice of the material to the 
applicant.

7(1)  The Maintenance Enforcement Regulation (AR 2/86) is 
amended by this section.
(2)  The Schedule is amended 
	(a)	by repealing Form 1 and substituting the following:
Form 1 
Statement of Finances
COURT FILE NUMBER	Clerk's Stamp:
MEP FILE NUMBER
COURT OF QUEEN'S BENCH OF ALBERTA	
JUDICIAL CENTRE	
RECIPIENT (Maintenance Creditor):	
PAYOR (Maintenance Debtor):	
DOCUMENT		AFFIDAVIT - STATEMENT 
		OF FINANCES                    
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
NOTICE TO THE MAINTENANCE DEBTOR: 
You are required under the Maintenance Enforcement Act to 
return a Statement of Finances when requested by the 
Maintenance Enforcement Program. The form must be fully 
completed and returned within 15 days of the date the Statement 
is mailed to you. For items that do not apply, please mark as 
"n/a" or "not applicable".
If you do not return a Statement of Finances when requested, 
you will be required to pay a $200 penalty or you will be subject 
to prosecution. Debtors who are prosecuted are subject to a fine 
of up to $2,000 or three months imprisonment, or both.
I, __________ of __________, Alberta, MAKE OATH AND SAY:
1.	I am the maintenance debtor in this matter;
2.	Paragraphs A through M below completely and accurately 
disclose my entire financial situation today:
A.	Debtor Information
   (last name)       (first name)       (middle name)       (birthdate)   
   (present address (mailing address))      (area code)      (home phone no.)   
			   (area   (daytime    
   (city)   (province)   (postal code)  (email address)      code)  phone no.)  
   (street address or land description (if different from mailing address))    
       (social               (driver's           (personal         (area         (cell       
  insurance no.)      licence no.)        health no.)     code)         phone no.)  
    (maiden name      (full name of your spouse 
   of your mother)     or common-law partner)       (area code)    (fax no.)    
  (list your trade, profession or occupation)                    	
Are you a member of a Union?                                ? Yes    ? No
If yes, which local(s)?  	
B.	Income  (If income is from self-employment, see Paragraph C)
   (name of present employer)               (area code)     (business phone no.)  
   (present address (street address))                       (area code)       (fax no.)   
  (city)              (province)            (postal code)                 (email address)   
    (nature of business)                   (position held)                    (start date)     
  $(gross monthly wages or salary)        $(net monthly wages or salary)       
  (name of previous employer #1)          (area code)  (business phone no.)    
   (present address (street address))                           (area code)  (fax no.)    
  (city)              (province)            (postal code)                (email address)    
    (nature of business)                   (position held)                   (start date)      
   $(gross monthly            $(net monthly 
     wages or salary)         wages or salary)                             (end date)        
  (name of previous employer #2)          (area code)  (business phone no.)    
   (present address (street address))                           (area code)  (fax no.)    
  (city)              (province)            (postal code)                 (email address)   
    (nature of business)                   (position held)                    (start date)     
   $(gross monthly           $(net monthly 
     wages or salary)         wages or salary)                              (end date)       
What is your annual bonus from your employer?	$     
How much money per year do you receive from commission work? 	$     
How much of a raise will you be receiving this year, and when?  
Date:                              	$     
How much money do you receive from other part-time employment?	$     
Provide name, current address, telephone number of all part-time  
employers: 	
How much money do you receive from income-producing hobbies?	$     
List all other income (dividends, rental income, annuities, pensions, etc.) 
	$      
Annual income tax and/or GST rebates, Universal Child Care Benefit, 
Child Tax Credit                                                                           	$      
*List additional household income (spousal, adult interdependent 
partner, roommate, etc.)	$      
			TOTAL MONTHLY INCOME       $     
Have you filed income tax returns within the past 3 years?	? Yes ? No
If yes, provide the following information or attach copies of your returns 
or Notices of Assessment:
(taxation year)	$(net taxable income)
C.	Income from Self-Employment
List any businesses in which you are involved as an owner, part owner, 
shareholder, director or officer.  If the business is a proprietorship, 
partnership or joint venture, list the names, addresses and telephone 
numbers of any partners, principals or participants:
   (name)               (address)               (area code)                (telephone no.)   
    (type of business)    (name of business)    (area code)    (telephone no.)   
   (business location (street address))	
   (city)              (province)              (postal code)              (email address)   
Is this business a:   ?   proprietorship	?   partnership
                               ?  joint venture	?   corporation
What is the percentage of the business owned by you?	      %
What is the net book value of the business?	$        
What is the estimated market value of the business?	$        
Itemize your yearly income from this business below:
Salary			$        
Bonuses	$        
Dividends	$        
Other income (automobile allowances, expenses, etc.)  	$        
(itemize and describe)	$        
Other benefits you receive from this business (company car, house, loans, 
savings plans, share purchase options, etc.):
(itemize and describe)	$(value)      
Total Annual Income (of both sections above)	$        
Include a copy of the business's most recent Financial Statement.
Where are the business's bank accounts located?
   (name of institution)       (branch)        (address)     (account no.)   
If the business is a corporation, complete the following:
    ?  public corporation	?  professional corporation
    ?  private corporation	?  other (describe)             
Are you an Officer or Director of the corporation?	? Yes ? No
If yes, what is your title?  	
If the business is NOT a public corporation, complete the following:
Total number of shares issued and outstanding:
   (class)                        (number)                            $(net book value)
Total number of shares of each class held by you:
   (class)                        (number)                            $(net book value)
Total amount of all loans payable to you by the corporation:
Amount	$                   
Interest earned (if any)	$                   
Terms of repayment:  		
D.	Monthly Expenses


Total 
Expense
Amount 
Paid by You
1.
Rent or mortgage payments 
(name of landlord or mortgagee)   
 
$             
 
$             
2.
Property taxes
$             
$             
3.
Utilities
$             
$             
4.
Groceries (food, toiletries, etc.)
$             
$             
5.
Clothing
$             
$             
6.
Transportation (fuel, parking, repairs, 
public transit, etc.)
 
$             
 
$             
7.
Personal expenses (prescription drugs, 
medical and dental expenses, expenses 
not covered by insurance, etc.)
 
 
$             
 
 
$             
8.
Home or rental insurance
$             
$             
9.
Vehicle insurance
$             
$             
10.
Life insurance
$             
$             
11.
Disability insurance, etc.
$             
$             
12.
Maintenance
$             
$             
13.
Alcohol, tobacco, other dependencies
$             
$             
14.
Other (specify)
$             
$             
15.    List your monthly payments (loans, credit cards, personal debts, etc.):
  (type of          (to whom       $(amount          $(monthly        $(amount paid 
   debt)               payable)       outstanding)       payment)   	by you)    
			TOTAL MONTHLY EXPENSES      $           
E.	Dependants
List the members of your household who are financially dependent on you:
   (name of dependants)          (date of birth)            (relationship to you)    
List all orders or agreements requiring you to pay child or spousal 
maintenance:
         (date of                     (amount payable        (person       
      order/agreement)             per month)            payable to)        $(arrears)  
F.	Assets
Bank Accounts:  List all chequing and savings accounts, term deposits, 
annuities, etc.:
  (name of financial   (branch             (type of 
       institution)          address)           deposit)    (account no.)      $(amount)
In the last 2 years have you used the services of a payday loan company or 
immediate cheque cashing service? (e.g. Payday Loans or MoneyMart)
? Yes  ? No
           (name of company)                                    (address)	
Retirement Savings Plans:  Provide information about all RRSPs, LIRAs, 
LIFs, LRIFs, pensions, etc.:
   (name of financial       (branch           (type         (account       $(current 
       institution)                address)        of plan)         no.)	     value)    
Real Estate:  Fill in the required information regarding all real estate 
(homes, rental properties, cottages, condominiums, etc.) inside and outside 
the Province of Alberta in which you own an interest:
   (municipal          (legal         $(purchase     $(balance   	$(current market   
      address)        description)        price)           owing)                  value)    
List the name and address of the mortgagee/lender for each property 
described above: 	
Motor Vehicles, etc.:  Fill in the requested information regarding all motor 
vehicles (cars, trucks, farm machinery, construction equipment, recreation 
vehicles, aircraft, etc.) in which you own an interest:
  (type   make     (serial    $(purchase    $(balance   $(current market   
   model   year)    no.)          price)           owing)           value)        $(equity)
Securities:  List your shares, bonds, etc. and their current market value:
   (type)       (number)           (dividends (if any))      $(current market value)
List location of all certificates for all corporate holdings (both public and 
private) and the name(s) and address(es) of the brokers through whom you 
deal:
   (location of certificates)                        (name and address of broker)       
G.	Insurance
List all insurance policies that you own or in which you are a named 
beneficiary.  Include the insurance company granting the policy, the policy 
number, the amount, the person insured, the premium and its cash 
surrender value:
(insurance    (policy                      (person                            $(cash surrender 
  company)    no.)    $(amount)     insured)    $(premium)             value)	
H.	Property Held By A Trustee
List all properties or interests held by a trustee on your behalf:
   (description of        	(name and address    
      assets held)                           (location of assets)    	of trustee)   
I.	Parties Who Owe You Money
List all parties who owe you money:
    (name) 
    (reason for debt)                      (address)                  $(amount owing)   
Are you the plaintiff in any lawsuit that may result in the court awarding
money to you? 	? Yes ? No
    (name of person being sued)	$(amount claimed)    
    (your lawyer's name)	(address)       
    (area code) (phone no.)	(status of court action)      
Have you settled a lawsuit for a sum of money that has not been paid yet? 
		? Yes  ? No
    (your lawyer's name)  	  (amount owing)       (payment date) 
    (lawyer's address)	(lawyer's (area code) (phone no.))   
    (status of court action (if any))	
Have you registered any debts owed to you against property? 
		? Yes  ? No
    (description of debt)  	  (description of property)     
    (registration number of debt)	(serial no. of property)      
    (name and address of owner)  	
Have you applied for any benefit, refund, compensation, grant, settlement 
or other funds from any government department or program? 
	? Yes  ? No
   (government department  	(reasons           
          or program)                   $(amount applied for)	for application) 
J.	Inheritances
List all estates in which you are the beneficiary of an inheritance:
    (deceased's name)	(name of executor/administrator)    
    (address of executor/administrator)	 
    (name of lawyer acting for estate)	$(value of inheritance)
K.	Other Assets
List the kind, value and location of other assets (whether solely or jointly 
owned) below:
Type of Asset
Description
Sole Owner
Location
Value


Yes  No


Interests in other 
businesses

?  ?

$
Promissory notes,  
judgment debts

?  ?

$
Loans and mortgages 
receivable

?  ?

$
Objects of art, jewellery, 
bullion, coins, cameras

?  ?

$
Household furnishings and 
appliances (stereos, TVs, 
computers, crystal, 
dishwashers, etc.)

?  ?

$
Other assets not previously 
listed

?  ?

$
Cash (including foreign 
currencies)



$CDN
L.	Transfer of Property
Have you given away, sold, assigned or otherwise transferred any property 
(land, buildings, vehicles, money, household furnishings, etc.) to anyone 
within the last 12 months?  Give details:
    (description           (to whom          (date of          $(amount of  money    
    of property)           transferred)       transfer)          received by you)   
M.	Bankruptcy
Have you begun a bankruptcy proceeding for which you have not been 
discharged?	? Yes  ? No
    (name and address of trustee/agent)	(area code) (phone no.)   
Sworn before me	) 
on  __________________, 20____,	) 
at                                        , Alberta	)	                                     
_____________________________             )   Signature of Debtor 
A Commissioner for Oaths in and  
for the Province of Alberta
or a Notary Public
	(b)	Form 5 is amended by striking out "Notice of Motion" 
and substituting "Application".
	(c)	by repealing Form 6 and substituting the following:
Form 6 
Maintenance Enforcement Support Agreement
COURT FILE NUMBER	Clerk's Stamp:
MEP FILE NUMBER
COURT OF QUEEN'S BENCH OF ALBERTA	
JUDICIAL CENTRE	
RECIPIENT (Maintenance Creditor):	
PAYOR (Maintenance Debtor):	
DOCUMENT		MAINTENANCE ENFORCEMENT 
		SUPPORT AGREEMENT             
1.  ?	This agreement requires the payment of support for a (former) 
spouse or adult interdependent partner. We, the Payor and 
Recipient, certify there has never been a court order previously 
granted requiring the Payor to pay spousal or adult interdependent 
partner support for the Recipient.
    ?	This agreement requires the payment of support for the child(ren) 
named below. We, the Payor and Recipient, certify there has never 
been
	(a)	a court order, or
	(b)	an agreement under Part 5 of the Income and Employment 
Supports Act, the Parentage and Maintenance Act or the 
Income Support Recovery Act
	requiring the Payor to pay support to the Recipient for any of the 
children named below.
   (full name of child)	(birthdate (yyyy/mm/dd))   
2.	Previous Maintenance Enforcement Support Agreements
	a.   ?	We have not previously made any Maintenance 
Enforcement Support Agreements between us relating to 
child, spousal or adult interdependent partner support,
	b.   ?	This agreement replaces the Maintenance Enforcement 
Support Agreement previously made between us on   
   (yyyy/mm/dd)   , which was filed with the Court of 
Queen's Bench, Judicial Centre of                     , on 
   (yyyy/mm/dd)    as Court Action No.      , or
	c.   ?	This agreement supplements the Maintenance Enforcement 
Support Agreement previously made between us on 
   (yyyy/mm/dd)   , which was filed with the Court of 
Queen's Bench, Judicial Centre of                          , on 
   (yyyy/mm/dd)    as Court Action No.      .  Where there is 
a conflict between the two agreements, the terms of this 
agreement will be used.
IT IS AGREED THAT:
3.	Guideline Income
	a.	The Payor's annual income as calculated in accordance with the 
Child Support Guidelines is $                         .
	b.	The Recipient's annual income as calculated in accordance with 
the Child Support Guidelines is $                      .
4.	Base Child Support
	a.	The Payor shall pay to the Recipient the sum of $                 per 
month for the support of the child(ren) named above.
	b.	?   Payment will be made on the              day of each month 
	commencing    (yyyy/mm/dd)   , or
	       ?	Payment will be made in two equal instalments of $           , 
payable on the               and                days of each month, 
commencing    (yyyy/mm/dd)   .
5.	Adjustment of Child Support by the Director of 
	Maintenance Enforcement
		When the Director of Maintenance Enforcement is provided with 
evidence that satisfies the Director that one or more children named 
above are no longer financially dependent on the Recipient, or 
otherwise do not qualify for the collection of support under the 
policies of the Maintenance Enforcement Program, the Director will 
adjust the amount of support payable as follows:
	a.	If one child is no longer eligible for support collection, then 
the base child support payment shall be reduced to $             
per month.
	b.	If          children are no longer eligible for support 
collection, then the base child support payment shall be 
reduced to $               per month.
6.	Additional Expenses Relating to the Child(ren)
	a.   ?	Monthly Payments:
	In addition to the base child support payment, the Payor shall pay to 
the Recipient the sum of $              per month for additional expenses 
for the child(ren) on the           day of each month commencing   
   (yyyy/mm/dd)   , calculated as follows:
	                              (type of                                $(amount of        
    (name of            additional                                  payor's             
       child)              expenses)                                 contribution)   
	Should the Recipient cease to incur any additional expense listed 
above, then the Payor shall no longer be required to contribute to that 
expense.
	b.   ?	One-time or Yearly Payments:
	In addition to any other payments required by this agreement, the 
Payor shall pay to the Recipient the following additional expenses for 
the children:
	                    (type of     $(amount of    ? payable       ? payable 
  (name of    additional     payor's            one time          yearly 
    child)      expense)    contribution)   (yyyy/mm/dd)    (mm/dd)
	Should the Recipient cease to incur any additional expense listed 
above, then the Payor shall no longer be required to contribute to that 
expense.
7.	Termination of Child Support and Expenses
	The obligation of the Payor to pay child support and expenses for a 
child terminates
	a.   ?	on the child no longer being considered a "child of the 
marriage" within the meaning of the Divorce Act (Canada),
	b.   ?	on the child no longer being considered a "child" within the 
meaning of Part 3 of the Family Law Act, or
	c.   ?		.
8.	Monthly Spousal or Adult Interdependent Partner 
	Support
	a.	The Payor shall pay to the Recipient the sum of $            
per month for the support of the Recipient.
	b.   ?	Payment will be made on the            day of each month 
commencing    (yyyy/mm/dd)   , or
	      ?	Payment will be made in two equal instalments of $           , 
payable on the             and                     days of each month, 
commencing    (yyyy/mm/dd)   .
9.	Termination of Spousal or Adult Interdependent Partner 
	Support
	The obligation of the Payor to pay support for the Recipient 
terminates
	a.	?	on                      (yyyy/mm/dd)  	, or
	b.	?		.
10.	One-time Spousal or Adult Interdependent Partner 
	Support
	The Payor shall pay to the Recipient, for the support of the Recipient, 
a one-time payment of $             , payable on    (yyyy/mm/dd)   .
11.	Enforcement by the Director of Maintenance Enforcement
	It is intended that this agreement be registered with the Director of 
Maintenance Enforcement and that payments made under this 
agreement be made pursuant to the Maintenance Enforcement Act to 
the Director of Maintenance Enforcement.
12.	Date of Agreement
	This agreement is entered into on    (yyyy/mm/dd)    at    (city or 
town)   , Alberta.
  (address of Recipient)	 
  (signature of Recipient)        (yyyy/mm/dd)        (print name of Recipient) 
  (signature of witness)            (yyyy/mm/dd)        (print name of witness)
   (address of Payor)	 
  (signature of Payor)              (yyyy/mm/dd)           (print name of Payor)    
  (signature of witness)          (yyyy/mm/dd)           (print name of witness)
Affidavit of Execution (Recipient)
	My name is:           (name of witness)	 
My address is:       (address of witness)	
	I make oath and say that I was personally present and did see    (name 
of Recipient)   , who is
	   ?	personally known to me, or
	   ?	known to me on the basis of photographic identification 
provided
	to be the person named herein, sign and execute the Maintenance 
Enforcement Support Agreement for the purpose named therein.
Sworn before me	) 
on  __________________, 20____,	) 
at                                        , Alberta	)	                                     
___________________________                 )   Signature of Witness 
A Commissioner for Oaths in and  
for the Province of Alberta
or a Notary Public
                                                                                   
Print or Stamp Name and Appointment Expiry Date
Affidavit of Execution (Payor)
	My name is:         (name of witness)	 
My address is:      (address of witness)	
	I make oath and say that I was personally present and did see    (name 
of Payor)   , who is
	   ?	personally known to me, or
	   ?	known to me on the basis of photographic identification 
provided
	to be the person named herein, sign and execute the Maintenance 
Enforcement Support Agreement for the purpose named therein.
Sworn before me	) 
on  __________________, 20____,	) 
at                                        , Alberta	)	                                     
_____________________________             )   Signature of Witness 
A Commissioner for Oaths in and  
for the Province of Alberta
or a Notary Public

                                                                                   
Print or Stamp Name and Appointment Expiry Date

8   The Mandatory Testing and Disclosure Regulation 
(AR 190/2007) is amended in Schedule 1 by striking out 
"Originating Notice of Application for Testing Order" and 
substituting "Application for Testing Order".

9(1)  The Matrimonial Property Regulation (AR 13/99) is 
amended by this section.
(2)  The Schedule is amended by repealing the form headed 
"CERTIFICATE OF LIS PENDENS" and substituting the 
following:
Certificate of Lis Pendens 
 
Matrimonial Property Act
COURT FILE NUMBER	Clerk's Stamp:
COURT OF QUEEN'S BENCH OF ALBERTA	
JUDICIAL CENTRE	
PLAINTIFF(S)	
DEFENDANT(S)	
DOCUMENT		CERTIFICATE OF 
		LIS PENDENS     
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
To:  Registrar of Land Titles
This is to certify that proceedings have been taken in    (here 
identify the court and the action number)    under the Matrimonial 
Property Act in which                                      claims an interest in 
the lands of                                                          , and no instrument 
purporting to affect lands in respect of which this certificate of lis 
pendens is filed shall be registered unless the instrument is 
expressed to be subject to that claim.
Dated this              day of                                              , 20            .
			   (Court Clerk)   

10(1)   The Public Trustee General Regulation (AR 241/2004) 
is amended by this section.
(2)  Section 15(1)(a)(i) is amended by striking out "next 
friend" and substituting "litigation representative".
(3)  The Schedule is amended in Form 9
	(a)	in the heading by striking out "Next Friend" and 
substituting "Litigation Representative";
	(b)	by striking out "next friend" wherever it occurs and 
substituting "litigation representative".

11(1)   The Workers' Compensation Regulation 
(AR 325/2002) is amended by this section.
(2)  Schedule C is repealed and the following is substituted:
Schedule C 
 
Certificate 
 
Workers' Compensation Act
COURT FILE NUMBER
COURT OF QUEEN'S BENCH OF ALBERTA	Clerk's Stamp:
JUDICIAL CENTRE	
PLAINTIFF              WORKERS' COMPENSATION BOARD
DEFENDANT	
DOCUMENT		CERTIFICATE
ADDRESS FOR SERVICE AND 
CONTACT INFORMATION OF 
PARTY FILING THIS DOCUMENT
The Workers' Compensation Board (the "WCB"), pursuant to 
section 127 of the Workers' Compensation Act, hereby certifies 
that:
	(a)	there is payable by the above defendant to the WCB the 
amount of $                            ;
	(b)	the basis of the payment is 	.
The WCB hereby directs the above defendant to make payment to 
the WCB of the said amount.
This certificate is filed pursuant to the Alberta Rules of Court 
(AR 124/2010).
Dated at                    , Alberta, this       day of                       , 20      .
WORKERS' COMPENSATION BOARD 
                                                 
Per: SECRETARY
Account No.