LOCAL AUTHORITIES ELECTION FORMS REGULATION - Alberta Queen's Printer
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Province of Alberta
LOCAL AUTHORITIES ELECTION ACT
LOCAL AUTHORITIES ELECTION
FORMS REGULATION
Alberta Regulation 106/2007
With amendments up to and including Alberta Regulation 264/2018
Current as of January 1, 2019
Office Consolidation
© Published by Alberta Queen’s Printer
Alberta Queen’s Printer
Suite 700, Park Plaza
10611 - 98 Avenue
Edmonton, AB T5K 2P7
Phone: 780-427-4952
Fax: 780-452-0668
E-mail: qp@gov.ab.ca
Shop on-line at www.qp.alberta.caCopyright and Permission Statement
Alberta Queen's Printer holds copyright on behalf of the Government of Alberta
in right of Her Majesty the Queen for all Government of Alberta legislation.
Alberta Queen's Printer permits any person to reproduce Alberta’s statutes and
regulations without seeking permission and without charge, provided due
diligence is exercised to ensure the accuracy of the materials produced, and
Crown copyright is acknowledged in the following format:
© Alberta Queen's Printer, 20__.*
*The year of first publication of the legal materials is to be completed.
Note
All persons making use of this consolidation are reminded that it has no
legislative sanction, that amendments have been embodied for convenience of
reference only. The official Statutes and Regulations should be consulted for all
purposes of interpreting and applying the law.(Consolidated up to 264/2018)
ALBERTA REGULATION 106/2007
Local Authorities Election Act
LOCAL AUTHORITIES ELECTION FORMS REGULATION
Forms
1(1) The forms set out in Schedule 1 are the English forms for use
under the Local Authorities Election Act.
(2) The forms set out in Schedule 2 are the French forms for use
under the Local Authorities Election Act.
(3) The forms set out in Schedules 2 and 3 are the forms for use
under the Local Authorities Election Act for the election of
members of a Regional authority as defined in the School Act.
Use of title
2 If a council has passed a bylaw under section 155 of the
Municipal Government Act, the title directed by that council for
“councillor” or “chief elected official” is the title that may, in that
local jurisdiction, replace councillor or chief elected official on the
forms in the Schedules.
3 Repealed AR 264/2018 s2.
Repeal
4 The Local Authorities Election Forms Regulation
(AR 378/2003) is repealed.
Schedule 1
The following are the forms set out in this Schedule:
Form In respect
Number Form Title of Section
1 Oath of Returning Officer 16
2 Statement of Deputy, Substitute, Enumerator 16
and Constable
3 Notice of Nomination Day 26
3 SV Notice of Nomination Day for Summer 12,26
VillagesSchedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
4 Nomination Paper and Candidate’s
Acceptance
Local Authorities Election Act 12,21,22,23,
27,28,47,68.1,
151, Part 5.1
School Act 44(4)
5 Candidate Information 27
6 Notice of Election 12,35,46,53
7 Notice of Election and Requirements for Voter 12,35,46,53
Identification
8 Notice of Vote on a Bylaw or Question 7,12,35,46,53
9 Ballot 42,43,44
10 Instructions for Electors 45
11 Enumerator, Candidate or Official Agent 52
Proof of Identification for Section 52 Access
12 Campaign Worker Proof of Identification 52
13 Elector Register
Local Authorities Election Act 1(n.1),47,53,
54,59,78
School Act 44(4)
13 SV Elector Register for Summer Villages 1(n.1),12,47,
53,54,59,78
14 Statement of Voucher
Local Authorities Election Act 47,53,54,59
School Act 44(4)
15 Presiding Deputy’s Certification and 90,91
Statement on Completion of Ballot Count
16 Statement of Scrutineer or Official Agent 16(2),68.1,
69,70
17 Statement of Interpreter, Elector who is 72,78
Unable to Vote in the Usual Manner, Friend
or Relative of Elector who is Unable to Vote
in the Usual Manner
18 Note of Objection to a Ballot 87
19 Ballot Account and Result of Vote 54,77.2,88,89
20 Disclaimer before a Complaint 144
21 Disclaimer after Application 143
22 Request for Special Ballot Package 77.1
23 Special Ballot Package 77.1,77.2
24 Special Ballot Voting Instructions 77.1,77.2
25 Special Ballot Certificate Envelope 47,53,77.1,
77.2
26 Campaign Disclosure Statement and Financial 147.3,147.4
Statement
27 Registration of a Third Party 163
28 Third Party Advertising Contribution 180,181
Statement
2Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
FORM 1 OATH OF RETURNING OFFICER
Local Authorities Election Act
(Section 16)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
ELECTION DATE:
I, (name of person taking oath) , solemnly swear (affirm)
THAT I will diligently, faithfully and to the best of my ability execute
according to law the office of Returning Officer;
THAT I will not communicate to any person any information obtained at
an election or in the course of carrying out my duties as to the candidate or
candidates for whom a person has voted, or at a vote on a bylaw or
question, as to whether a person has voted for or against a bylaw or
question;
THAT, where applicable, I will not communicate to any person any
information obtained in the course of carrying out my duties as a returning
officer; and
THAT I will in all respects maintain and aid in maintaining the absolute
secrecy of the vote.
SWORN (AFFIRMED) BEFORE ME )
at the of , in the Province )
of Alberta, this day of ,) (Signature of Person Taking Oath)
20 . )
)
(Signature of Commissioner for Oaths)
IT IS AN OFFENCE TO SIGN A FALSE AFFIDAVIT
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under section 16(1) of the Local Authorities Election Act and
section 33(c) of the Freedom of Information and Protection of Privacy Act.
The personal information will be managed in compliance with the privacy
provisions of the Freedom of Information and Protection of Privacy Act.
If you have any questions concerning the collection of this personal
information, please contact
(title and business phone number of the responsible official)
FORM 2 STATEMENT OF DEPUTY,
SUBSTITUTE, ENUMERATOR
AND CONSTABLE
Local Authorities Election Act
(Section 16)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
ELECTION DATE:
I, (name of deputy, substitute, enumerator or constable) , solemnly
state
3Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
THAT I will diligently, faithfully and to the best of my ability execute
according to law the office of (office appointed to) ;
THAT I will not communicate to any person any information obtained at
an election or in the course of carrying out my duties as to the candidate or
candidates for whom a person has voted, or at a vote on a bylaw or
question, as to whether a person has voted for or against a bylaw or
question;
THAT, where applicable, I will not communicate to any person any
information obtained in the course of carrying out my duties as a deputy,
substitute, enumerator or constable; and
THAT I will in all respects maintain and aid in maintaining the absolute
secrecy of the vote.
(Signature of Deputy, Substitute,
Enumerator or Constable)
IT IS AN OFFENCE TO SIGN A FALSE STATEMENT
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under section 16(2) of the Local Authorities Election Act and
section 33(c) of the Freedom of Information and Protection of Privacy Act.
The personal information will be managed in compliance with the privacy
provisions of the Freedom of Information and Protection of Privacy Act.
If you have any questions concerning the collection of this personal
information, please contact
(title and business phone number of the responsible official)
FORM 3 NOTICE OF NOMINATION DAY
Local Authorities Election Act
(Section 26)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
Notice is hereby given that Nomination Day is (date) and that
nominations for the election of candidates for the following offices will be
received at the location of the local jurisdiction office set out below within
the period beginning on (date) and ending at 12:00 noon on
Nomination Day.
Office(s) Number of Vacancies Ward or Electoral Division
Number (If Applicable)
Location (Address) of Local Jurisdiction Office:
4Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
DATED at the of , in the
Province of Alberta, this day of , 20 .
(Returning Officer)
FORM 3 SV NOTICE OF NOMINATION DAY
FOR SUMMER VILLAGES
Local Authorities Election Act
(Sections 12, 26)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
Notice is hereby given that Nomination Day is (date) and that
nominations for the election of candidates for the following offices will be
received between the hours of (time) and (time) at (location) .
Office(s) Number of Vacancies
DATED at the of , in the
Province of Alberta, this day of , 20 .
(Returning Officer)
FORM 4 NOMINATION PAPER AND
CANDIDATE’S ACCEPTANCE
Local Authorities Election Act
(Sections 12, 21, 22, 23, 27, 28, 47,
68.1, 151, Part 5.1)
School Act (Section 44(4))
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
We, the undersigned electors of (name of local jurisdiction and ward, if
applicable) , nominate (candidate’s surname) (given names) of
(complete address and postal code) as a candidate at the election about
to be held for the office of (office nominated for) of (name of
local jurisdiction) .
Signatures of at least 5 ELECTORS ELIGIBLE TO VOTE in this
election in accordance with sections 27 and 47 of the Local Authorities
Election Act and section 44(4) of the School Act (if applicable). If a city or
a board of trustees under the School Act passes a bylaw under section 27(2)
of the Local Authorities Election Act, then the signatures of up to 100
electors eligible to vote may be required.
Printed Name Complete Address and Postal Code Signature of
of Elector of Elector Elector
5Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
CANDIDATE’S ACCEPTANCE
I, the above named candidate, solemnly swear (affirm)
THAT I am eligible under sections 21 and 47 (and section 12, in the case
of summer villages) of the Local Authorities Election Act and section 44(4)
of the School Act (if applicable) to be elected to the office;
THAT I am not otherwise disqualified under section 22 or 23 of the Local
Authorities Election Act;
THAT I will accept the office if elected;
THAT I have read sections 12, 21, 22, 23, 27, 28, 47, 68.1, and 151 and
Part 5.1 of the Local Authorities Election Act and section 44(4) of the
School Act (if applicable) and understand their contents;
THAT I am appointing (name, contact information or complete address
and postal code, and telephone number of official agent) (if applicable)
as my official agent;
THAT I will read and abide by the municipality’s code of conduct if
elected (if applicable); and
THAT the electors who have signed this nomination paper are eligible to
vote in accordance with the Local Authorities Election Act and the School
Act and resident in the local jurisdiction on the date of signing the
nomination.
Print name as it should appear on the ballot
(Candidate’s Surname) (Given Names) (may include
nicknames, but not titles,
i.e. Mr., Ms, Dr.)
SWORN (AFFIRMED) BEFORE ME )
at the of , in the Province )
of Alberta, this day of , ) (Candidate’s Signature)
20 . )
)
(Signature of Returning Officer or
Commissioner for Oaths)
IT IS AN OFFENCE TO SIGN A FALSE AFFIDAVIT
OR A FORM THAT CONTAINS A FALSE STATEMENT
6Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under sections 21 and 27 of the Local Authorities Election Act
and section 33(c) of the Freedom of Information and Protection of Privacy
Act. The personal information will be managed in compliance with the
privacy provisions of the Freedom of Information and Protection of
Privacy Act. If you have any questions concerning the collection of this
personal information, please contact
(title and business phone number of the responsible official)
RETURNING OFFICER’S ACCEPTANCE
Returning Officer signals acceptance by signing this form:
Signature of Returning Officer
FORM 5 CANDIDATE INFORMATION
Local Authorities Election Act
(Section 27)
Candidate’s Full Name, Address and Postal Code:
Address of place(s) where candidate records are maintained
Name(s) and address(es) of financial institutions where campaign
contributions will be deposited (if applicable):
Name(s) of signing authorities for each depository listed above (if
applicable):
Where there is any change in the above mentioned information, the
candidate shall notify the local jurisdiction in writing within 48 hours of
such changes by submitting a completed information form.
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under section 27 of the Local Authorities Election Act and
section 33(c) of the Freedom of Information and Protection of Privacy Act.
The personal information will be managed in compliance with the privacy
provisions of the Freedom of Information and Protection of Privacy Act.
If you have any questions concerning the collection of this personal
information, please contact
(title and business phone number of the responsible official)
FORM 6 NOTICE OF ELECTION
Local Authorities Election Act
(Sections 12, 35, 46, 53)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
7Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
Notice is hereby given that an election will be held for the filling of the
following offices:
Office(s) Number of Vacancies Ward or Electoral Division
Number (If Applicable)
Voting will take place on the day of , 20 ,
between the hours of (start time) and (closing time) . Voting stations
will be located at:
In order to vote, your name must appear on the list of electors. If your
name does not appear on the list of electors, the person vouching for you
must produce identification for inspection. The identification must be one
or more of (list acceptable forms of identification) as required by section
53 of the Local Authorities Election Act.
DATED at the of , in the
Province of Alberta, this day of , 20 .
(Returning Officer)
FORM 7 NOTICE OF ELECTION
AND REQUIREMENTS FOR
VOTER IDENTIFICATION
Local Authorities Election Act
(Sections 12, 35, 46, 53)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
Notice is hereby given that an election will be held for the filling of the
following offices:
Office(s) Number of Vacancies Ward or Electoral Division
Number (If Applicable)
Voting will take place on the day of , 20 ,
between the hours of (start time) and (closing time) . Voting stations
will be located at:
In order to vote, you must produce identification for inspection. The
identification must be one or more of (list acceptable forms of
identification) as required by section 53 of the Local Authorities Election
Act.
8Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
DATED at the of , in the
Province of Alberta, this day of , 20 .
(Returning Officer)
FORM 8 NOTICE OF VOTE ON A BYLAW
OR QUESTION
Local Authorities Election Act
(Sections 7, 12, 35, 46, 53)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
Notice is hereby given that a vote of the electors will be held on the
following:
(Specify Bylaw or Question to be voted on)
Voting will take place on the day of , 20 ,
between the hours of (start time) and (closing time) . Voting stations
will be located at:
In order to vote, your name must appear on the list of electors, if any, and
if your name does not appear on the list of electors, the person vouching
for you must produce identification for inspection. If there is no list of
electors, you must produce identification for inspection. The identification
must be one or more of (list acceptable forms of identification) as
required by section 53 of the Local Authorities Election Act.
DATED at the of , in the
Province of Alberta, this day of , 20 .
(Returning Officer)
FORM 9 BALLOT
Local Authorities Election Act
(Sections 42, 43, 44)
BALLOT FORM FOR CHIEF ELECTED OFFICIAL (CEO)
(List Names of Candidates Below)
ELECTION OF CEO
FOR THE
(Local Jurisdiction)
This ballot shall not be marked for more than
one candidate.
BALLOT FORM FOR OTHER OFFICES
(List Names of Candidates Below)
ELECTION OF
(Office)
9Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
FOR THE
(Local Jurisdiction)
The maximum number of candidates that can
be voted for is (number) .
USING SEPARATE BALLOTS FOR EACH OFFICE
A separate ballot must be used for:
● the office of chief elected official;
● the offices of councillors;
● the offices of school trustees.
BALLOT FOR A VOTE ON A BYLAW OR QUESTION
The wording on a ballot for a vote on a bylaw or question must be
determined by a resolution of the elected authority. The form of the ballot
may be determined by a resolution of the elected authority; however, if no
resolution is passed, the returning officer must determine the form.
ARRANGING THE NAMES ON THE BALLOTS
The names of the candidates on each ballot must be arranged
alphabetically in order of the surnames and, if 2 or more candidates have
the same surname, the names of those candidates must be arranged
alphabetically in order of their given names.
If an elected authority passes a bylaw 2 months before an election that
provides that ballots be printed in as many lots as there are candidates for
the office, section 43(3) of the Local Authorities Election Act applies.
INDICATING THE NUMBER OF CANDIDATES THAT CAN BE
VOTED FOR
Every ballot used in an election for a member of an elected authority must
contain a brief explanatory note stating the maximum number of
candidates that can be voted for in order not to make the ballot subject to
being rejected, and every ballot used in an election for chief elected
official must contain a brief explanatory note stating that the ballot shall
not be marked for more than one candidate.
BALLOTS FOR PUBLIC OR SEPARATE MEMBERS
Every ballot should indicate if the elector is voting for a public or separate
candidate.
FORM 10 INSTRUCTIONS FOR ELECTORS
Local Authorities Election Act
(Section 45)
TO VOTE:
Mark each ballot by placing an “X” in the space provided on the right hand
side opposite the name of the candidate(s) of your choice. The ballot
indicates the maximum number of candidates that can be voted for. You
may vote for less than the maximum number, but not for more.
10Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
EXAMPLES OF HOW TO MARK BALLOTS
BALLOT FORM FOR THE ELECTION OF
CHIEF ELECTED OFFICIAL (CEO)
Name One
ELECTION OF CEO Name Two X
FOR THE
(Local Jurisdiction) Name Three
This ballot shall not be marked for more
than one candidate.
BALLOT FORM FOR OTHER THAN THE ELECTION OF
CHIEF ELECTED OFFICIAL (CEO)
Name One
ELECTION OF Name Two X
(Office)
FOR THE Name Three X
(Local Jurisdiction)
Name Four
Name Five X
The maximum number of candidates
that can be voted for is 3.
Fold each ballot so that your markings are concealed and the initials of the
deputy who issued the ballot(s) are visible.
AFTER MARKING YOUR BALLOT(S)
Hand the ballot(s) to the deputy supervising the ballot box. The deputy
will, after verifying the initials on the ballot(s), deposit the ballot(s) in the
ballot box or, at your request, return the ballot(s) to you for deposit in the
ballot box.
You have now completed the voting process. Please leave the voting
station.
BYLAW OR QUESTION BALLOT
In the case of a ballot for a bylaw or question, mark the ballot by placing
an “X” opposite either “For” or “Against” or opposite either “Yes” or
“No”.
SPOILED BALLOT(S)
If you have marked your ballot in error, or defaced it in any way, you may
return it and obtain a replacement from the deputy who gave it to you.
If a ballot is torn, defaced or otherwise dealt with by an elector so that the
elector can be identified, the ballot is rejected and shall not be counted.
- A PERSON MAY VOTE ONLY ONCE -
11Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
IT IS AN OFFENCE TO TAKE A BALLOT
OUT OF A VOTING STATION
FORM 11 ENUMERATOR, CANDIDATE OR
OFFICIAL AGENT PROOF
OF IDENTIFICATION FOR
SECTION 52 ACCESS
Local Authorities Election Act
(Section 52)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
ELECTION DATE:
VOTING SUBDIVISION OR WARD (If Applicable):
For the purposes of access authorized under section 52 of the
Local Authorities Election Act, this constitutes identification for
(name) of (complete address and postal code) serving in the
capacity of (office) .
This appointment is in effect for the 20__ campaign period.
Section 52 of the Local Authorities Election Act states that a person to
whom an enumerator, a candidate, an official agent or a campaign worker
on behalf of a candidate has produced identification in the prescribed form,
indicating that the person is an enumerator, a candidate, an official agent or
a campaign worker, shall not
(a) obstruct or interfere with, or
(b) cause or permit the obstruction or interference with
the free access of the enumerator, candidate, official agent or campaign
worker to each residence in a building containing 2
or more residences or to each residence in a mobile home park.
(Signature of Returning Officer
or Deputy Returning Officer)
(Signature of Enumerator, Candidate
or Official Agent named above)
FORM 12 CAMPAIGN WORKER PROOF
OF IDENTIFICATION
Local Authorities Election Act
(Section 52)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
ELECTION DATE:
VOTING SUBDIVISION OR WARD (If Applicable):
For the purposes of access authorized under section 52 of the Local
Authorities Election Act, this constitutes identification for (name) of
(complete address and postal code) serving in the capacity of
(office) .
12Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
This appointment is in effect for the 20__ campaign period.
Section 52 of the Local Authorities Election Act states that a person to
whom an enumerator, a candidate, an official agent or a campaign worker
on behalf of a candidate has produced identification in the prescribed form,
indicating that the person is an enumerator, a candidate, an official agent or
a campaign worker, shall not
(a) obstruct or interfere with, or
(b) cause or permit the obstruction or interference with
the free access of the enumerator, candidate, official agent or campaign
worker to each residence in a building containing 2
or more residences or to each residence in a mobile home park.
(Candidate’s Signature) (Campaign Worker’s Signature)
FORM 13 ELECTOR REGISTER
Local Authorities Election Act
(Sections 1(n.1), 47, 53, 54, 59, 78)
School Act (Section 44(4))
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
ELECTION DATE:
VOTING SUBDIVISION OR WARD (If Applicable):
VOTING STATION:
STATEMENT OF ELECTOR ELIGIBILITY
I, (name of elector) , of (complete address and postal
code) , am eligible to vote at the above mentioned election because:
● I have not voted before in this election;
● I am 18 years of age or older;
● I am a Canadian citizen;
● My place of residence is in the Voting Subdivision
on Election Day;
● I have provided the required proof of eligibility as required
by section 53 of the Local Authorities Election Act, or I
have been vouched for as to my eligibility by an elector; and
● I am eligible to vote for:
Where applicable: (Check [√] One) □ A Public School Trustee
□ A Separate School Trustee
(Signature of Elector)
IT IS AN OFFENCE TO SIGN A FALSE STATEMENT
DEPUTY RETURNING OFFICER (Deputy’s Initials)
VOTER NUMBER:
□ Identification Shown □ Elector Vouched For
BALLOTS ISSUED TO ELECTOR (Check [√])
13Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
□ Chief Elected Official □ Bylaw or Question
□ Councillors □ Separate School Trustee
□ Public School Trustee
OBJECTION Name of Candidate/Official
TO PERSON Agent/R.O./Scrutineer
VOTING Making Objection:
Reason for Objection:
ELECTOR Ballot of Elector who is Unable to Vote in the
WHO IS Usual Manner Was Marked By Another Person:
UNABLE TO (Check [√]) □
VOTE IN THE
USUAL
MANNER
Reason:
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under sections 53, 54 and 78 of the Local Authorities Election
Act and section 33(c) of the Freedom of Information and Protection of
Privacy Act. The personal information will be managed in compliance
with the privacy provisions of the Freedom of Information and Protection
of Privacy Act. If you have any questions concerning the collection of this
personal information, please contact
(title and business phone number of the responsible official)
FORM 13 SV ELECTOR REGISTER
FOR SUMMER VILLAGES
Local Authorities Election Act
(Sections 1(n.1), 12, 47, 53, 54, 59, 78)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
ELECTION DATE:
VOTING SUBDIVISION OR WARD (If Applicable):
VOTING STATION:
STATEMENT OF ELECTOR ELIGIBILITY
I, (name of elector) , of (complete address and postal
code) , am eligible to vote at the above mentioned election
because:
● I have not voted before in this election;
● I am 18 years of age or older;
● I am a Canadian citizen;
● I have provided the required proof of eligibility as required by
section 53 of the Local Authorities Election Act, or I have been
vouched for as to my eligibility by an elector; and
● I am named on the Certificate of Title as the person who owns
property within the summer village, or I am the spouse or adult
interdependent partner of the person named
or
14Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
● My place of residence is in the Summer Village on Election Day.
(Signature of Elector)
IT IS AN OFFENCE TO SIGN A FALSE STATEMENT
DEPUTY RETURNING OFFICER (Deputy’s Initials)
VOTER NUMBER:
□ Identification Shown □ Elector Vouched For
BALLOTS ISSUED TO ELECTOR (Check [√])
□ Chief Elected Official □ Bylaw or Question
□ Councillors
OBJECTION TO Name of Candidate/Official Agent/R.O./Scrutineer
PERSON Making Objection:
VOTING
Reason for Objection:
ELECTOR WHO Ballot of Elector who is Unable to Vote in the
IS UNABLE TO Usual Manner Was Marked By Another Person:
VOTE IN THE (Check [√]) □
USUAL
MANNER
Reason:
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under sections 12, 53, 54 and 78 of the Local Authorities
Election Act and section 33(c) of the Freedom of Information and
Protection of Privacy Act. The personal information will be managed in
compliance with the privacy provisions of the Freedom of Information and
Protection of Privacy Act. If you have any questions concerning the
collection of this personal information, please contact
(title and business phone number of the responsible official)
FORM 14 STATEMENT OF VOUCHER
Local Authorities Election Act
(Sections 47, 53, 54, 59)
School Act (Section 44(4))
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
ELECTION DATE:
VOTING SUBDIVISION OR WARD (If Applicable):
15Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
VOTING STATION:
STATEMENT OF VOUCHER
I, (name of elector) , of (complete address and postal code) , state
● that I personally know the following who live(s) at the
address(es) indicated:
Print name Print residential address
● that I am eligible to vote at the above mentioned election;
● that my name properly appears on the list of electors for this
voting station (if applicable);
● that I have provided the required proof of eligibility as required by
section 53 of the Local Authorities Election Act, and
● that I truly believe the person(s) named above is (are) ordinarily
resident at the address(es) listed above and is (are) eligible to vote
at the above mentioned election.
(Signature of Voucher)
IT IS AN OFFENCE TO SIGN A FALSE STATEMENT
DEPUTY RETURNING OFFICER (Deputy’s Initials)
□ Name of vouching elector appears on the list of electors
for voting subdivision (if applicable).
□ Identification Shown
OBJECTION TO Name of Candidate/Official
PERSON Agent/R.O./Scrutineer Making Objection:
VOUCHING
Reason for Objection:
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under sections 53 and 54 of the Local Authorities Election Act
and section 33(c) of the Freedom of Information and Protection of Privacy
Act. The personal information will be managed in compliance with the
privacy provisions of the Freedom of Information and Protection of
Privacy Act. If you have any questions concerning the collection of this
personal information, please contact
(title and business phone number of the responsible official)
16Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
FORM 15 PRESIDING DEPUTY’S CERTIFICATION
AND STATEMENT ON COMPLETION
OF BALLOT COUNT
Local Authorities Election Act
(Sections 90, 91)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
ELECTION DATE:
VOTING SUBDIVISION OR WARD (If Applicable):
VOTING STATION:
I, (name of presiding deputy) , certify that the number of persons who
have this day signed the elector register to vote at this voting station
is (figures) (words) , and that to the best of my knowledge and
belief the entries in the elector register, which are required by law to be
made, were correctly made.
(Signature of Presiding Deputy Returning Officer)
IT IS AN OFFENCE TO SIGN A FALSE STATEMENT
FORM 16 STATEMENT OF SCRUTINEER
OR OFFICIAL AGENT
Local Authorities Election Act
(Sections 16(2), 68.1, 69, 70)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
ELECTION DATE (OR VOTE ON A BYLAW OR
QUESTION):
I, (name of scrutineer or official agent) , of
(complete address and postal code) in the Province of
(name of province) , am at least 18 years of age and,
(a) FOR THE PURPOSES OF AN ELECTION, will act as
scrutineer on behalf of (name of candidate) for the office
of (office for which candidate was nominated)
OR
(b) FOR THE PURPOSES OF A VOTE ON A BYLAW, will act
as scrutineer for those persons who are interested in
(Check [√] One) □ promoting the passing of
Bylaw No.
□ opposing the passing of
Bylaw No.
OR
(c) FOR THE PURPOSES OF A VOTE ON A QUESTION, will
act as scrutineer on behalf of those persons who are interested in
17Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
(Check [√] One) □ voting in the positive on the
question set out
□ voting in the negative on the
question set out
AND I will in all respects maintain and aid in maintaining the absolute
secrecy of the vote.
(Signature of Scrutineer or Official Agent)
IT IS AN OFFENCE TO SIGN A FALSE STATEMENT
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under sections 16(2), 68.1, 69 and 70 of the Local Authorities
Election Act and section 33(c) of the Freedom of Information and
Protection of Privacy Act. The personal information will be managed in
compliance with the privacy provisions of the Freedom of Information and
Protection of Privacy Act. If you have any questions concerning the
collection of this personal information, please contact
(title and business phone number of the responsible official)
FORM 17 STATEMENT OF INTERPRETER,
ELECTOR WHO IS UNABLE TO VOTE
IN THE USUAL MANNER, FRIEND OR
RELATIVE OF ELECTOR WHO IS UNABLE
TO VOTE IN THE USUAL MANNER
Local Authorities Election Act
(Sections 72, 78)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
ELECTION DATE:
VOTING SUBDIVISION OR WARD (If Applicable):
VOTING STATION:
STATEMENT OF INTERPRETER
I, (name of interpreter) , of (complete address and
postal code) in the Province of Alberta, will faithfully read
or translate such statements, questions and answers that the
deputy returning officer may require to be read or translated □
at this election and I will keep secret all information which Deputy’s
may come to me by virtue of being the interpreter Initials
for (name of elector) .
(Signature of Interpreter)
18Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
STATEMENT OF ELECTOR WHO IS UNABLE TO
VOTE IN THE USUAL MANNER
VERBAL STATEMENT
Are you, (name of elector who is unable to vote in the
usual manner) , of (complete address and postal
code) in the Province of Alberta, unable to mark your □
ballot in the usual manner and you require assistance? Deputy’s
Initials
(Instruction to Deputy: Initial if the elector answers
affirmatively to this question.)
STATEMENT OF FRIEND OR RELATIVE OF
ELECTOR WHO IS UNABLE TO VOTE IN THE
USUAL MANNER
I, (name of friend or relative of elector who is unable to
vote in the usual manner) , of (complete address and
postal code) in the Province of Alberta, am the friend or
relative of (name of elector who is unable to vote in the
usual manner) , an elector who is unable to vote in the
usual manner. I will read the ballot to my friend or relative, □
mark the ballot in accordance with the elector’s instructions, Deputy’s
and keep secret all information which may come to me by Initials
virtue of assisting the elector.
(Signature of Friend or Relative of Elector
who is Unable to Vote in the Usual Manner)
IT IS AN OFFENCE TO MAKE OR
SIGN A FALSE STATEMENT
(FILE WITH ELECTOR’S ELECTOR REGISTER FORM)
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under sections 72(2) and 78 of the Local Authorities Election
Act and section 33(c) of the Freedom of Information and Protection of
Privacy Act. The personal information will be managed in compliance
with the privacy provisions of the Freedom of Information and Protection
of Privacy Act. If you have any questions concerning the collection of this
personal information, please contact
(title and business phone number of the responsible official)
FORM 18 NOTE OF OBJECTION TO A BALLOT
for (Name of Office, Bylaw or Question)
Local Authorities Election Act
(Section 87)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
19Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
ELECTION DATE:
VOTING SUBDIVISION OR WARD (If Applicable):
VOTING STATION:
Objection Name of Official Agent, Scrutineer Reason for
Number or Candidate Making Objection Objection
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under section 87 of the Local Authorities Election Act and
section 33(c) of the Freedom of Information and Protection of Privacy Act.
The personal information will be managed in compliance with the privacy
provisions of the Freedom of Information and Protection of Privacy Act.
If you have any questions concerning the collection of this personal
information, please contact
(title and business phone number of the responsible official)
FORM 19 BALLOT ACCOUNT
AND RESULT OF VOTE
for (Name of Office, Bylaw or Question)
Local Authorities Election Act
(Sections 54, 77.2, 88, 89)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
ELECTION DATE:
VOTING SUBDIVISION OR WARD (If Applicable):
VOTING STATION:
20Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
Result of Vote
Number of VALID Ballots
Marked for Each Candidate
Names of Candidates (or For and Against on a
(or Question, or Description of Bylaw) Question or Bylaw)
(Continue on Reverse if Required)
Ballot Account
(a) Number of Ballots Supplied
(b) Number of Special Ballots Sent Out +
======*
(c) Valid Ballots
(d) Valid Special Ballots Received +
(e) Rejected Ballots +
(f) Rejected Special Ballots +
(g) Spoiled Ballots +
(h) Unused Ballots +
(i) Ballots Not Accounted For +
(j) Special Ballots Not Returned +
(k) Total ======*
*Total number of ballots in (a) and (b) must equal (k), the total
number of ballots in (c), (d), (e), (f), (g), (h), (i) and (j).
Persons objected to under section 54
Valid Ballots for: Number of Ballots:
Candidate
Candidate
Candidate
Candidate
Candidate
Candidate
Candidate
Candidate
Candidate
Candidate
Candidate
Candidate
Valid Ballots Objected To ____________
Rejected Ballots On Which No Vote
Was Cast by an Elector ____________
DATED this day of , 20 .
(Signatures of at least 2 Deputies) (Signatures of Candidates/
Official Agents/Scrutineers
who desire to sign)
21Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
(HAND THIS FORM TO THE RETURNING OFFICER)
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under section 88 of the Local Authorities Election Act and
section 33(c) of the Freedom of Information and Protection of Privacy Act.
The personal information will be managed in compliance with the privacy
provisions of the Freedom of Information and Protection of Privacy Act.
If you have any questions concerning the collection of this personal
information, please contact
(title and business phone number of the responsible official)
FORM 20 DISCLAIMER BEFORE A COMPLAINT
Local Authorities Election Act
(Section 144)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
I, (name of person disclaiming) , solemnly swear (affirm) that I
disclaim all right to the office of of (name of local
jurisdiction) and all defence of any right I may have to it.
SWORN (AFFIRMED) BEFORE ME )
at the of , in the Province )
of Alberta, this day of ,) (Signature of Person Taking Oath)
20 . )
)
(Signature of Returning Officer or
Commissioner for Oaths)
IT IS AN OFFENCE TO SIGN A FALSE AFFIDAVIT
FORM 21 DISCLAIMER AFTER APPLICATION
Local Authorities Election Act
(Section 143)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
I, (name of person disclaiming) , on whom an application for judicial
review for an order in the nature of quo warranto has been served for the
purpose of contesting my right to the office of
(name of office) of (name of local jurisdiction) , solemnly
swear (affirm) that I disclaim that office and all defence of any right I may
have to it.
SWORN (AFFIRMED) BEFORE ME )
at the of , in the Province )
of Alberta, this day of ,) (Signature of Person Taking Oath)
20 . )
)
(Signature of Returning Officer or
Commissioner for Oaths)
IT IS AN OFFENCE TO SIGN A FALSE AFFIDAVIT
22Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
FORM 22 REQUEST FOR SPECIAL BALLOT PACKAGE
Local Authorities Election Act
(Section 77.1)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
ELECTION DATE:
VOTING SUBDIVISION OR WARD (If Applicable):
VOTING STATION:
I, (printed first name and surname) , of (complete municipal address and
postal code) , request a Special Ballot package which will include one of
each of the following ballots:
Please select: □ A Public School Trustee
□ A Separate School Trustee
□ Chief Elected Official
□ Councillors
□ Bylaw or Question
Please select one: (Election official to fill in if application is made by
telephone.)
□ I would like my Special Ballot package sent by regular mail to the
following address: (complete address to which the application will
be mailed, including the postal code).
□ I will arrange for my Special Ballot package to be picked up during
regular office hours. I would like my package held for pick-up.
(date of request)
Contact telephone number:
Contact e-mail address:
Reason why a special ballot is requested:
□ physical disability
□ absence from the local jurisdiction
□ being a returning officer, deputy returning officer, constable,
substitute returning officer, candidate, official agent or scrutineer
who may be located on election day at a voting station other than that
for the elector’s place of residence
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under section 77.1 of the Local Authorities Election Act and
section 33(c) of the Freedom of Information and Protection of Privacy Act.
The personal information will be managed in compliance with the privacy
provisions of the Freedom of Information and Protection of Privacy Act.
If you have any questions concerning the collection of this personal
information, please contact
23Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
(title and business phone number of the responsible official)
FORM 23 SPECIAL BALLOT PACKAGE
Local Authorities Election Act
(Sections 77.1, 77.2)
SPECIAL BALLOT
SPECIAL BALLOT FORM FOR CHIEF ELECTED OFFICIAL
(List Names of Candidates below if known
prior to Application for Special Ballot in
the following Ballot Format)
ELECTION OF CEO
FOR THE
(Local Jurisdiction)
This ballot shall not be marked for more
than one candidate.
SPECIAL BALLOT FORM FOR OTHER ELECTED OFFICES
(If Application for Special Ballot is sent prior
to Special Ballots being printed with List of
Candidates Names, use the following Ballot
Format)
ELECTION OF Print the name(s) of the candidates on the
(Office) lines below.
FOR THE
(Local Jurisdiction) I vote for:
The maximum number of candidates that can
be voted for is (number) .
USING SEPARATE BALLOTS FOR EACH OFFICE
A separate ballot must be used for:
● the office of chief elected official;
● the offices of councillors;
● the offices of school trustees;
● any questions.
BALLOT FOR A VOTE ON A BYLAW OR QUESTION
The wording on a ballot for a vote on a bylaw or question must be
determined by a resolution of the elected authority. The form of the ballot
may be determined by a resolution of the elected authority; however, if no
resolution is passed, the returning officer must determine the form in
accordance with section 44 of the Local Authorities Election Act.
24Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
ARRANGING THE NAMES ON THE BALLOTS
The names of the candidates on each ballot must be arranged
alphabetically in order of the surnames and, if 2 or more candidates have
the same surname, the names of those candidates must be arranged
alphabetically in order of their given names.
If an elected authority passes a bylaw 2 months before an election that
provides that ballots be printed in as many lots as there are candidates for
the office, section 43(3) of the Local Authorities Election Act applies.
INDICATING THE NUMBER OF CANDIDATES THAT
CAN BE VOTED FOR
Every ballot used in an election for a member of an elected authority must
contain a brief explanatory note stating the maximum number of
candidates that can be voted for in order not to make the ballot subject to
being rejected, and every ballot used in an election for chief elected
official must contain a brief explanatory note stating that the ballot shall
not be marked for more than one candidate.
BALLOTS FOR PUBLIC OR SEPARATE MEMBERS
Every ballot should indicate if the elector is voting for a public or separate
candidate.
FORM 24 SPECIAL BALLOT VOTING INSTRUCTIONS
Local Authorities Election Act
(Sections 77.1, 77.2)
SPECIAL BALLOT VOTING INSTRUCTIONS
You are eligible to complete a Special Ballot if you are unable to vote at
an advance voting station or at the voting station on Election Day due to:
● physical disability;
● absence from the local jurisdiction; or
● being a returning officer, deputy returning officer, substitute
returning officer, constable, candidate, official agent or
scrutineer who may be located on Election Day at a voting
station other than that for the elector’s place of residence.
1. Mark an “X” in the space provided on the right hand side opposite
the name of the candidate(s) of your choice, or, if a blank ballot,
mark the ballot by printing the name of the candidate(s) of your
choice in the space provided with a pen or pencil. The ballot
indicates the maximum number of candidates that can be voted for.
You may vote for less than the maximum number, but not for more.
2. Place all ballot(s), marked or not, in the Special Ballot Envelope and
seal the envelope.
3. Place the Special Ballot Envelope in the Special Ballot Certificate
Envelope.
4. Complete and sign Part I of the Special Ballot Certificate Envelope
and seal the envelope.
5. Attach a photocopy of your identification to the Special Ballot
Certificate Envelope. Your identification must be one or more
25Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
of (list acceptable forms of identification) as required by section
53 of the Local Authorities Election Act.
6. Place the Special Ballot Certificate Envelope in the Outer Mailing
Envelope and seal the envelope.
7. It is your responsibility to ensure that this Outer Mailing Envelope,
complete with all prescribed contents, arrives at the office of the
returning officer prior to ____ on Election Day, which is:
Election Day: (date to be entered by returning officer)
(day) (month) (year)
8. Failure to complete any of these steps may invalidate your ballot.
FORM 25 SPECIAL BALLOT CERTIFICATE ENVELOPE
Local Authorities Election Act
(Sections 47, 53, 77.1, 77.2)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
ELECTION DATE:
VOTING SUBDIVISION OR WARD (If Applicable):
VOTING STATION:
Part I
To be completed by Elector
STATEMENT OF ELECTOR ELIGIBILITY
I, (name of elector) , of (complete address and postal code) , am
eligible to vote at the above mentioned election because:
● I have not voted before in this election;
● I am 18 years of age or older;
● I am a Canadian citizen;
(a) my place of residence is in the Voting Subdivision or Ward
on Election Day; or
(b) I am named on the Certificate of Title as the person liable
to pay property taxes for property within the summer
village or I am the spouse or adult interdependent partner
of the person named;
● I have provided the required proof of eligibility as required by
section 53 of the Local Authorities Election Act;
● I am entitled to receive a Special Ballot in accordance with
sections 77.1 and 77.2 of the Local Authorities Election Act
because I will not be able to attend advance voting stations, if
any, or the voting station established for my local jurisdiction,
due to physical disability, absence from the local jurisdiction or
being a returning officer, substitute returning officer, deputy
returning officer, constable, candidate, official agent or
scrutineer.
26Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
I declare that the above statements are true.
Dated at (complete address and postal code where Special Ballot
Certificate Envelope is received) this (date) day of
(month) , (year) .
(Signature of Elector)
IT IS AN OFFENCE TO SIGN A FALSE STATEMENT
Part II
To be completed by Returning Officer
CHECK:
□ Name of the individual recorded on the front of envelope is
recorded in the Special Ballot Voting Register.
□ Part I is properly completed.
□ Elector’s identification meets the requirements of section 53 of
the Local Authorities Election Act.
□ Special Ballot Certificate Envelope IS accepted.
OR
Special Ballot Certificate Envelope IS NOT opened because:
□ Part I is not properly completed,
□ Elector’s identification does not meet the requirements of
section 53 of the Local Authorities Election Act, or
□ Received after the close of voting stations on Election Day.
Date and Time Received:
(Initials of Returning Officer)
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under sections 53 and 77.2 of the Local Authorities Election Act
and section 33(c) of the Freedom of Information and Protection of Privacy
Act. The personal information will be managed in compliance with the
privacy provisions of the Freedom of Information and Protection of
Privacy Act. If you have any questions concerning the collection of this
personal information, please contact
(title and business phone number of the responsible official)
27Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
FORM 26 CAMPAIGN DISCLOSURE STATEMENT
AND FINANCIAL STATEMENT
Local Authorities Election Act
(Sections 147.3, 147.4)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
Full name of Candidate:
Candidate’s mailing address
, Alberta
Postal Code
This form, including any contributor information from line 2,
is a public document.
Pre-Campaign Period Report
1. Pre-Campaign Period Contributions
(up to a limit of $2,000) $
2. Pre-Campaign Period Expenses
(up to a limit of $2,000) $
Campaign Period Revenue
CAMPAIGN CONTRIBUTIONS:
1. Total amount of contributions of
$50.00 or less $
2. Total amount of all contributions of $50.01
and greater, together with the contributor’s
name and address (attach listing and amount) $
NOTE:
For lines 1 and 2, include all money and valued personal property, real
property or service contributions.
3. Deduct total amount of contributions returned $
4. NET CONTRIBUTIONS (line 1 + 2 - 3) $
OTHER SOURCES:
5. Total amount contributed out of candidate’s
own funds $
6. Total net amount received from fund-raising
functions $
7. Transfer of any surplus or deficit from a
candidate’s previous election campaign $
8. Total amount of other revenue $
9. TOTAL OTHER SOURCES
(add lines 5, 6, 7 and 8) $
10. Total Campaign Period Revenue
(add lines 4 and 9) $
28Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
Campaign Period Expenditures
11. Total Campaign Period Expenses
Paid Unpaid TOTAL $
The Candidate must attach an itemized expense report to this form.
Campaign Period Surplus (Deficit)
(deduct line 11 from line 10) $
ATTESTATION OF CANDIDATE
This is to certify that to the best of my knowledge this document and all
attachments accurately reflect the information required under section 147.4
of the Local Authorities Election Act.
Signature of Candidate Date
Forward the signed original of this document to the address of the local
jurisdiction in which the candidate was nominated for election.
IT IS AN OFFENCE TO FILE A FALSE STATEMENT
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under section 147.4 of the Local Authorities Election Act and
section 33(c) of the Freedom of Information and Protection of Privacy Act.
The personal information will be managed in compliance with the privacy
provisions of the Freedom of Information and Protection of Privacy Act.
If you have any questions concerning the collection of this personal
information, please contact
(title and business phone number of the responsible official)
FORM 27 REGISTRATION OF A THIRD PARTY
Local Authorities Election Act
(Section 163)
□ Initial Registration □
Update to Registration
___________________________________________________________
(Name of Third Party)
REGISTRATION TYPE
□ Election Advertising □ Political Advertising
ENTITY TYPE
□ Person □ Group □ Corporation
PRIMARY CONTACT
Name (include title: Mr., Ms, Dr.)
Mailing address
, Alberta
Postal Code
E-mail
Primary Phone
29Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
Alternate Phone
CHIEF FINANCIAL OFFICER (CFO)
Name (include title: Mr., Ms, Dr.)
Mailing address
, Alberta
Postal Code
E-mail
Primary Phone
Alternate Phone
LOCATION RECORDS ARE MAINTAINED AND
COMMUNICATIONS ADDRESSED (IF OTHER THAN CFO’S
ADDRESS)
Name (include title: Mr., Ms, Dr.)
Mailing address
, Alberta
Postal Code
E-mail
Primary Phone
Alternate Phone
FINANCIAL INSTITUTION
Name
Mailing address
, Alberta
Postal Code
E-mail
Office Phone
Signing Officer(s)
NOTES
1. If the third party requesting registration is a Corporation, the
Primary Contact information must be that of the officer who has
signing authority for it.
2. If the third party requesting registration is a Group, the Primary
Contact information must be that of the Principal Officer or
Principal Member. A listing of all Officers or Members must also
be attached to this application.
3. Where there is any change in the above mentioned information, the
registered third party shall notify the local jurisdiction in writing
within 30 days of such changes by submitting a completed
registration form.
4. A copy of the resolution authorizing the third party to incur political
and/or election advertising expenses, as indicated above under
Registration Type, must be included if the third party has a
governing body.
30Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
ENDORSEMENT BY THIRD PARTY CFO
(for initial registration or change to registration information)
(Printed Name)
(Signature of CFO)
(Date)
ACCEPTANCE BY LOCAL JURISDICTION
(for initial registration or change to registration information)
(Authorized Signature)
(Local Jurisdiction)
(Date)
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under section 163 of the Local Authorities Election Act and
section 33(c) of the Freedom of Information and Protection of Privacy Act.
The personal information will be managed in compliance with the privacy
provisions of the Freedom of Information and Protection of Privacy Act.
If you have any questions concerning the collection of this personal
information, please contact
(title and business phone number of the responsible official)
FORM 28 THIRD PARTY ADVERTISING
CONTRIBUTION STATEMENT
Local Authorities Election Act
(Sections 180, 181)
LOCAL JURISDICTION: , PROVINCE OF ALBERTA
Third Party Name:
Third Party’s mailing address
, Alberta
Postal Code
Election Advertising Period
ADVERTISING CONTRIBUTIONS:
1. Total amount of contributions of
$250.00 or less $
2. Total amount of all contributions of $250.01
and greater $
Complete the following table for all contributions of $250.01 and greater,
attaching additional sheets as necessary.
31Schedule 1 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
Contributions of $250.01 and Greater
Contributor’s Contributor’s Amount of Date of
Name Address Contribution Contribution
NOTE:
For lines 1 and 2, and the table, include all money and real property, goods
or service contributions.
Forward the signed original of this document to the address of the local
jurisdiction in which the third party is registered.
Political Advertising Period
ADVERTISING CONTRIBUTIONS:
1. Total amount of contributions of
$250.00 or less $
2. Total amount of all contributions of $250.01
and greater $
Complete the following table for all contributions of $250.01 and greater,
attaching additional sheets as necessary.
Contributions of $250.01 and greater
Contributor’s Contributor’s Amount of Date of
Name Address Contribution Contribution
NOTE:
For lines 1 and 2, and the table, include all money and real property, goods
or service contributions.
Forward the signed original of this document to the address of the local
jurisdiction in which the third party is registered.
NOTE:
The personal information on this form is being collected to support the
administrative requirements of the local authorities election process and is
authorized under sections 180 and 181 of the Local Authorities Election
32Schedule 2 LOCAL AUTHORITIES ELECTION FORMS REGULATION AR 106/2007
Act and section 33(c) of the Freedom of Information and Protection of
Privacy Act. The personal information will be managed in compliance
with the privacy provisions of the Freedom of Information and Protection
of Privacy Act. If you have any questions concerning the collection of this
personal information, please contact
(title and business phone number of the responsible official)
AR 106/2007 Sched. 1;68/2008;81/2010;164/2010;
73/2013;264/2018
Schedule 2
Les formulaires suivants sont contenus dans cette annexe.
Numéro du Selon
formulaire Titre du formulaire l’article
1RA Serment du directeur du scrutin 16
2RA Déclaration du scrutateur, du 16
remplaçant, du recenseur et du
préposé au service d’ordre
3RA Avis du jour de déclaration de 26
candidatures
4RA Mise en candidature et consentement
du candidat
Local Authorities Election Act 12,21,22,23,
27,28,47,
68.1,151,
Partie 5.1
School Act 256
5RA Informations du candidat 27
6RA Avis d’élection 35,46,53
7RA Avis d’élection et exigences relatives 35,46,53
à l’identification de l’électeur
8RA Avis de vote sur un règlement ou une 7,35,46,53
question donnée
9RA Bulletin de vote
Local Authorities Election Act 42,43,44
School Act 256
10RA Instructions à l’intention des électeurs 45
11RA Preuve d’identification du recenseur, 52
candidat ou agent officiel en matière
d’accès conformément à l’article 52
12RA Preuve d’identification du travailleur 52
de campagne électorale
33You can also read
