Election Act Forms Regulation

(Consolidated up to 241/2022) ALBERTA REGULATION 69/2018 Election Act ELECTION ACT FORMS REGULATION Election Act forms 1 (1) The forms in the Schedule to this Regulation are prescribed for the purposes of the sections of the Election Act indicated on the forms. (2) The forms required to be prescribed under the Election Act that are not set out in the Schedule are to be prescribed by the Chief Electoral Officer. Repeal 2 The Election Act Forms Regulation (AR 141/2011) is repealed. Schedule Form 1 (Section 39) Writ of Election Canada Province of Alberta Charles the Third, by the Grace of God, of the United Kingdom, Canada and His other Realms and Territories, King, Head of the Commonwealth, Defender of the Faith. To , Returning Officer of the Electoral Division of . 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 , 20__, and that in the event that voting is necessary you do cause voting to take place 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 , 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: This writ received on the day of , 20 Chief Electoral Officer Returning Officer Form 2 (Sections 45.1(9) ) Appointment and Oath of Election Officer (other than a returning officer, election clerk or enumerator) I, (print name) of (print address) , appointed as (position) in the Electoral Division of , Voting Area number (complete if applicable) , in the Province of Alberta, swear (or affirm) that I am not a member of the Parliament of Canada, a member of the Legislative Assembly, a councillor under the Municipal Government Act , a trustee of a board of trustees under the Education Act , a candidate, an official agent, or a judge of a federal or provincial court, and that I have not within the immediately preceding 10 years been convicted of an indictable offence where the penalty that may be imposed for that offence is greater than 2 years’ imprisonment and that I will act impartially and diligently in carrying out my duties under the Election Act . Sworn (or affirmed) before me ) at the of , ) (signature of election officer) in the Province of Alberta, this ) day of , 20 . ) ) (signature of authorized person) ) Print name: Authority to administer oath: A person who takes a false oath under the Election Act commits an offence and is liable to a fine of not more than $50 000 or to imprisonment for not more than 2 years or to both a fine and imprisonment. Form 3 (Sections 9(5) and 47(5) ) Appointment and Oath of Returning Officer and Election Clerk I, (print name) of (print address) , appointed as (position) in the Electoral Division of , in the Province of Alberta, swear (or affirm) that I am not a member of the Parliament of Canada, a member of the Legislative Assembly, a councillor under the Municipal Government Act , a trustee of a board of trustees under the Education Act , a candidate, an official agent, or a judge of a federal or provincial court, and that I have not within the immediately preceding 10 years been convicted of an indictable offence where the penalty that may be imposed for that offence is greater than 2 years’ imprisonment and that I am an elector. I understand that, while I am appointed as a returning officer or election clerk, I may not engage in political activity on behalf of any political party, candidate or constituency association, and that I may not make a contribution under the Election Finances and Contributions Disclosure Act . I will act impartially and diligently in carrying out my duties under the Election Act . Sworn (or affirmed) before me ) at the of , ) (signature of election officer) in the Province of Alberta, this ) day of , 20 . ) ) (signature of authorized person) ) Print name: Authority to administer oath: A person who takes a false oath under the Election Act commits an offence and is liable to a fine of not more than $50 000 or to imprisonment for not more than 2 years or to both a fine and imprisonment. Form 4 (Section 28) Appointment and Oath of Enumerator I, (print name) of (print address) , appointed as (enumerator) in the Electoral Division of , Voting Area number (complete if applicable) , in the Province of Alberta, swear (or affirm) that I am not a member of the Parliament of Canada, a member of the Legislative Assembly, a candidate, an official agent, or a judge of a federal or provincial court, and that I have not within the immediately preceding 10 years been convicted of an indictable offence where the penalty that may be imposed for that offence is greater than 2 years’ imprisonment and that I will act impartially and diligently in carrying out my duties under the Election Act . Sworn (or affirmed) before me ) at the of , ) (signature of enumerator) in the Province of Alberta, this ) day of , 20 . ) ) (signature of authorized person) ) Print name: Authority to administer oath: A person who takes a false oath under the Election Act commits an offence and is liable to a fine of not more than $50 000 or to imprisonment for not more than 2 years or to both a fine and imprisonment. Form 5 (Sections 83(5)) Form of Ballot FRONT OF BALLOT Stub Ballot CANDIDATE’S NAME NAME OF PARTY OR INDEPENDENT CANDIDATE’S NAME NAME OF PARTY OR INDEPENDENT CANDIDATE’S NAME NAME OF PARTY OR INDEPENDENT CANDIDATE’S NAME NAME OF PARTY OR INDEPENDENT BACK OF BALLOT 0 0 0 0 0 0 0 0 Stub INITIALS OF ELECTION OFFICER Electoral Division of Year (SECOND FOLD) Ballot (FIRST FOLD) Form 6 (Sections 186(1)) Form of Petition Controverted Election Clerk’s stamp: COURT FILE NUMBER COURT OF KING’S BENCH OF ALBERTA JUDICIAL CENTRE PETITIONER (Print name of petitioner) RESPONDENT (Print name of respondent) DOCUMENT PETITION — CONTROVERTED ELECTION ADDRESS FOR SERVICE AND CONTACT INFORMATION OF PARTY FILING THIS DOCUMENT The petition of (print name of petitioner) of (print residential address) shows that ● an election was held on the day of 20 , for the Electoral Division of at which the Respondent was a candidate and has been returned as the person elected at that election, ● the petitioner was a qualified elector at that election (or the petitioner was a defeated candidate at that election), and ● the petition is made by reason of undue return or undue election of the Respondent as a member of the Legislative Assembly, in particular (state here the facts and grounds on which the petitioner relies). The petitioner prays that it may be declared that the election of the Respondent is void and that it be set aside. Dated this day of , 20 . (signature of petitioner) AR 69/2018 Sched.;81/2019;208/2022;241/2022