O.C. 450/2004

A.R. 213/2004

September 29, 2004

The Lieutenant Governor in Council makes the Election Act Forms Regulation set out in the attached Appendix.

For Information only

Recommended by: Minister of Justice and Attorney General

Authority: Election Act
(section 207)

APPENDIX

Election Act

ELECTION ACT FORMS REGULATION

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2   The Election Forms Regulation (AR 369/92) is repealed.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

Number of Valid Ballots
(Total Columns A - L)

Number of Spoiled Ballots

(Ballots spoiled by electors and returned to DRO)

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

Number of Ballots Not Used

(Unused ballots returned to RO)

Number of Rejected Ballots

(Ballots deposited in ballot box but not counted as valid)

Number of Ballots Removed from Polling Place

Number of Ballots Sent to
Each Poll

(Total of Columns 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)