Missing Persons Regulation

(Consolidated up to 98/2026) ALBERTA REGULATION 151/2012 Missing Persons Act MISSING PERSONS REGULATION Table of Contents 1 Definition 2 Disclosure of information to parent of missing minor 3 Disclosure of information to guardian of represented adult 4 Practice and procedure 4.1 Time for compliance 5 Non‑compliance with this Regulation 6 Method of service 7 Retention and disposal of records 8 Forms 9 Expiry 10 Coming into force Schedule Definition 1 In this Regulation, (a) “Act” means the Missing Persons Act ; (a.1) “contact information” includes, without limitation, the residential address, including the postal code, of a person’s ordinary residence and any other addresses, telephone numbers or other information by which the person may ordinarily be contacted; (b) “mature minor” means an individual who (i) is under 18 years of age, (ii) has the ability to understand the nature of the information collected under the Act about or pertaining to the individual, and (iii) objects to the disclosure of some or all of the information to the individual’s parent or guardian and understands the consequences of the non-disclosure of that information to the individual’s parent or guardian; (c) “recorded mail” means recorded mail as defined in the Alberta Rules of Court (AR 124/2010); (d) “telecommunication” means the use of a method of electronic or telephonic communication in accordance with this Regulation. AR 151/2012 s2;50/2022 Disclosure of information to parent of missing minor 2 A police service may release a copy of the records or disclose the personal information collected under the Act concerning a missing person who is a minor, without the minor’s consent, to a parent or guardian of that minor after the minor has been located, if (a) the parent or guardian has made a written request to the police service for a copy of the records or disclosure of the personal information, (b) the investigating officer believes the release or disclosure will protect the safety of the minor, (c) the commanding officer of the police service agrees that the record should be released or the information should be disclosed on the basis that the release or disclosure will protect the safety of the minor, and (d) the commanding officer does not believe that the minor is a mature minor. Disclosure of information to guardian of represented adult 3 A police service may release a copy of the records or disclose the personal information collected under the Act of a missing person who is a represented adult under the Adult Guardianship and Trusteeship Act , without the represented adult’s consent, to a guardian of the represented adult, after the represented adult has been located, if (a) the guardian has made a written request for a copy of the records or disclosure of the personal information, (b) the investigating officer believes the release or disclosure will protect the safety of the represented adult, and (c) the commanding officer of the police service agrees that the records should be released or the information should be disclosed on the basis that the release or disclosure will protect the safety of the represented adult. Practice and procedure 4 (1) Subject to subsection (2), an application under section 3 or 5 of the Act may be made in person or by telecommunication. (2) The Court of Justice may issue directions for an application by telecommunication under section 3 or 5 of the Act. (3) Except as otherwise directed by a justice of the peace in accordance with subsection (4)(b), “service” in respect of an application or order under section 3 or 5 of the Act has the same meaning as the service of a written demand under section 6. (4) In any matter not provided for in the Act or this Regulation, a justice of the peace may (a) follow the Alberta Rules of Court (AR 124/2010) and the procedures of the Court of King’s Bench, and (b) give directions respecting any practice or procedure in the Court or when hearing an application under the Act. AR 151/2012 s3;50/2022;218/2022;76/2023 Time for compliance 4.1 (1) An order under section 3 or 5 of the Act must provide that within 48 hours from the time when the order was served, or such other time specified by the justice of the peace in the order, the required records or copies of the records shall either (a) be provided to the police service, or (b) if it is not possible for all requested records to be provided, the available records shall be provided together with a time estimate for the provision of the remaining records. (2) On request, an individual or organization subject to an order shall provide the police service with a time estimate as to when the required records or copies of the records shall be provided under subsection (1)(a). AR 50/2020 s4 Non‑compliance with this Regulation 5 No proceeding shall be defeated on the ground of an alleged defect in form. Method of service 6 (1) Service of a written demand under section 4(1) of the Act or an order of a justice of the peace that is required to be served is effected (a) on an individual by delivering it to the individual, (b) in the case of a corporation (i) by recorded mail, (ii) by leaving it with the individual who is the manager, secretary or other executive officer of the corporation or the person apparently in charge of a branch office of the corporation at an address held out by the corporation to be its address, or (iii) by sending it by facsimile or other form of electronic transmission to the corporation’s last known facsimile number or electronic address, if the sender receives confirmation that the transmission was successfully completed, (c) in the case of an entity who is not a corporation or an individual (i) by recorded mail, (ii) by delivering it to an officer or administrator of the entity who appears to have management or control responsibilities with respect to the entity, or (iii) by sending it by facsimile or other form of electronic transmission to the entity’s last known facsimile number or electronic address, if the sender receives confirmation that the transmission was successfully completed. (2) A justice of the peace, on application and on being satisfied that service cannot be made effectively in accordance with subsection (1), may by order authorize another method of service. Retention and disposal of records 7 (1) Records obtained under the authority of the Act (a) are, when the missing person has been safely located, to be disposed of within 90 days of the locating of the missing person, (b) may be retained if the missing person is not found or if the missing person is found dead, or (c) may be retained if any further investigations arise or are likely to arise regarding the disappearance of the missing person until any and all investigations are concluded. (2) Records obtained under the authority of the Act must be securely stored so that access to the records is limited to only those members of the police service who require access to perform their job function in accordance with the Act as determined by the commanding officer of the police service. (3) When records are disposed of, they are to be disposed of in accordance with the methods outlined in the police service’s approved records retention and disposition schedule for disposition of confidential records. Forms 8 The forms to be used in an application under the Act are the forms in the Schedule. Expiry 9 For the purpose of ensuring that this Regulation is reviewed for ongoing relevancy and necessity, with the option that it may be repassed in its present or an amended form following a review, this Regulation expires on November 30, 2031. AR 151/2012 s9;181/2018;199/2021;98/2026 Coming into force 10 This Regulation comes into force on the coming into force of the Missing Persons Act . Schedule Form 1 Application for Access to Records Section 3, Missing Persons Act Docket # In the Alberta Court of Justice In the matter of an application under section 3(1)(a) of the Missing Persons Act Regarding the Missing Person (name of missing person) Application [Remove any portions of the proposed application that are not needed.] 1 My name is (name of applicant) and I am a member of (police service) that is conducting a non‑criminal investigation into the whereabouts of the named missing person. 2 The named person has not been in contact with those persons who would likely be in contact with that person. 3 The named person’s whereabouts are unknown despite reasonable efforts to locate the person. 4 The named person’s safety and welfare are feared for given the person’s physical or mental capabilities or the circumstances surrounding the person’s absence. 5 The missing person is · a minor. · a represented adult under the Adult Guardianship and Trustee Act . 6 I am applying for an order authorizing the police service to obtain access to or copies of the following records that are needed to further the investigation: · records containing contact information or identification information, and in particular, (optional) ______________________________________ · telephone, internet and other electronic communication records for the periods of (date and time) to (date and time) including · ___________________________________________ · telephone records, and in particular, (optional) __________________________________ · records related to signals from a wireless device that may indicate the location of a wireless device, and in particular, (optional) _________________________ · cellular telephone records, and in particular, (optional) __________________________________ · incoming and outgoing text messaging or other instant messaging records, and in particular, (optional) __________________________________________ · browsing history records, and in particular, (optional) __________________________________ · online account activity information, and in particular, (optional) __________________________________ · any messages received or actions taken by or with a device during the listed period, and in particular, (optional) __________________________________ · global positioning system tracking records, and in particular, · __________________________________________ · for the periods of (date and time) to (date and time) for records existing for the portion of time before this Order is served and for records indicating the location of a wireless device that can be produced for the period of time from the time of service of this Order, and in particular, (optional) __________________________ · copies of or access to view, as requested by the police service, video records including closed‑circuit television footage, and in particular, (optional) ______________________________ · records containing employment information, and in particular, · __________________________________________ · indicating when and where the missing person was last seen or heard from, and in particular, (optional) __________________________________________ · indicating when, where and how the missing person was paid, and in particular, (optional) ____________________ · records containing health information, and in particular, · __________________________________________ · indicating admission or interaction with health services from (date) to (date) , and in particular, (optional)__________________________________ · indicating date, time and reason for hospital admission or interaction with health services during the stated period, and in particular, (optional) ____________________________________ · records containing school attendance information from (date) to (date) , and in particular, (optional) ______________________________________ · records containing travel and accommodation information , and in particular, · __________________________________________ · indicating when and where the missing person was last seen or heard from, and in particular, (optional) __________________________________ · records containing financial information, and in particular, · ____________________________________________ · indicating credit card usage from (date) to (date) ( where, when and for what purpose used ), and in particular, ( optional) ____________________________________ · indicating recent access to bank accounts (where, when and for what purpose the account was accessed) , and in particular, (optional) ____________________________ · copies of any other records as the justice of the peace considers appropriate, as follows: _____________________________ Affidavit [Remove any portions of the proposed Affidavit that are not needed.] 7 In support of my application, I make oath/affirm and say that · the police service has an active, ongoing non‑criminal investigation into the unexplained whereabouts of the missing person. · the investigative steps undertaken to date include the following: __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ · there is reason to believe that the missing person may be in the company of one or more other individuals, namely __________________________________________________ · I request that the following additional information be considered in support of my application: __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ · copies of or access to the records of or related to the missing person are needed to move the investigation forward. · copies of or access to the records of or related to other individual(s) in whose company the missing person may be or may have been are needed to move the investigation forward. · I believe that records of these types may exist and may contain information relevant to the investigation. SWORN/AFFIRMED BEFORE ME at (city or town) in the Province of Alberta on (yyyy/mm/dd) (Applicant’s signature) (Justice of the Peace or Commissioner for Oaths) Form 2 Order for Records Section 3, Missing Persons Act Docket # In the Alberta Court of Justice In the matter of an application under section 3(1)(a) of the Missing Persons Act Regarding the Missing Person (name of missing person) Order regarding records Heard by (name of Justice of the Peace) , a Justice of the Peace on (date) , 20 . (name of applicant) , member of (police service) , has applied for an order requiring access to or release of copies of records that may be of assistance in investigating the whereabouts of the missing person. On being satisfied that · _____________ is a missing person under the Act, · the police service is conducting a non‑criminal investigation into the whereabouts of the missing person, and · the applicant has a reasonable belief that the requested records will assist with the investigation, IT IS ORDERED THAT: [Remove any portions of the proposed Order that are not needed.] Copies of the following records containing information related to · the missing person, and · (name of individual) in whose company the missing person may be or may have been, in whoever’s possession the records may be, shall be made available to or provided to (police service) : · records containing contact information or identification information, and in particular, (optional) ________________________________________ · telephone, internet and other electronic communication records for the periods of (date and time) to (date and time) including · _____________________________________________ · telephone records, and in particular, (optional) ______________________________________ · records related to signals from a wireless device that may indicate the location of a wireless device, and in particular, (optional) ______________________________________ · cellular telephone records, and in particular, (optional) ______________________________________ · incoming and outgoing text messaging or other instant messaging records, and in particular, (optional) _______________________________________________ · browsing history records, and in particular, (optional) _______________________________________________ · online account activity information, and in particular, (optional) _______________________________________ · any messages received or actions taken by or with a device during the listed period, and in particular, (optional) ______________________________________ · global positioning system tracking records, and in particular, · _______________________________________________ · for the periods of (date and time) to (date and time) for records existing for the portion of time before this Order is served and for records indicating the location of a wireless device that can be produced for the period of time from the time of service of this Order, and in particular, (optional) ______________________________________ · copies of or access to view, as requested by the police service, video records including closed‑circuit television footage, and in particular, (optional) _________________________________ · records containing employment information, and in particular, · ______________________________________________ · indicating when and where the missing person was last seen or heard from, and in particular, (optional) ______________________________________ · indicating when, where and how the missing person was paid, and in particular, (optional) ________________________ · records containing health information, and in particular, · _______________________________________________ indicating hospital admission or interaction with health services from (date) to (date) , and in particular,(optional)________________________________ · indicating date, time and reason for hospital admission or interaction with health services during the stated period, and in particular, (optional)_______________________________________ · records containing school attendance information from (date) to (date) , and in particular, (optional) ___________________________________________ · records containing travel and accommodation information , and in particular, · _______________________________________________ · indicating when and where the missing person was last seen or heard from, and in particular, (optional) _______________________________________ · records containing financial information, and in particular, · _______________________________________________ · indicating credit card usage from (date) to (date) (where, when and for what purpose used) , and in particular, ( optional) _______________________________________ · indicating recent access to bank accounts (where, when and for what purpose the account was accessed) , and in particular, (optional) _______________________________________ · copies of any other records as the justice of the peace considers appropriate, as follows: ________________________________ · an accounting, as requested by the applicant, recording the steps taken by the persons on whom this Order is served to locate any records ordered to be produced above that the persons on whom this Order is served cannot find or that have not been produced. Compliance with this Order is required within 48 hours of service, or before (date and time) . This Order expires on (date and time) . (Justice of the Peace) Pursuant to the Missing Persons Act [SA 2011, s7(1)], any information or records collected under the Act by a police service are confidential and may not be disclosed except in accordance with section 7 of the Act and the regulations. Pursuant to the Missing Persons Regulation [AR 151/2012, s4.1(1)], where this Order requires a person to provide records or copies of records, the records or copies of the records shall either (a) be provided to the police service, or (b) if it is not possible for all requested records to be provided, the available records shall be provided together with a time estimate for the provision of the remaining records. Pursuant to the Missing Persons Regulation [AR 151/2012, s7], information or records collected under the Act (a) are, when the missing person has been safely located, to be disposed of within 90 days of the locating of the missing person, (b) may be retained if the missing person is not found or if the missing person is found dead, or (c) may be retained if any further investigations arise or are likely to arise regarding the disappearance of the missing person until any and all investigations are concluded. Form 3 Application for an Order for Entry Section 3, Missing Persons Act Docket # In the Alberta Court of Justice In the matter of an application under section 3(1)(b) of the Missing Persons Act Regarding the Missing Person (name of missing person) Application [Remove any portions of the proposed application that are not needed.] 1 My name is (name of applicant) and I am a member of (police service) that is conducting a non‑criminal investigation into the whereabouts of the named missing person. 2 The missing person is · a minor. · a represented adult under the Adult Guardianship and Trusteeship Act . 3 I am applying for an order authorizing a police officer (and name, position of other person) to enter, by force if necessary, and search the place or premises specified in my affidavit below to locate the missing person. Affidavit [Remove any portions of the proposed Affidavit that are not needed.] 4 In support of my application, I make oath/affirm and say that · the police service is conducting a non‑criminal investigation into the whereabouts of the missing person. · the investigative steps undertaken to date include the following: __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ · I request that the following additional information be considered in support of my application: __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ · I have reason to believe that the missing person may be found at the following location: ______________________________ SWORN/AFFIRMED BEFORE ME at (city or town) in the Province of Alberta on (yyyy/mm/dd) (Applicant’s signature) (Justice of the Peace or Commissioner for Oaths) Form 4 Order for Entry Section 3, Missing Persons Act In the Alberta Court of Justice In the matter of an application under section 3(1)(b) of the Missing Persons Act Regarding the Missing Person (name of missing person) Order for Entry [Remove any portions of the proposed Order that are not needed.] Heard by (name of Justice of the Peace) , a Justice of the Peace on (date) , 20 . (name of applicant) , member of (police service) , has applied for an order authorizing entry to ___________ by force if necessary to search for the missing person. On being satisfied that · ___________ is a missing person under the Act and that the police service is conducting a non‑criminal investigation into the whereabouts of the missing person, · the missing person is · a minor, or · a represented adult under the Adult Guardianship and Trusteeship Act , · the applicant has a reasonable belief that the missing person may be located at this location: ________________________________, IT IS ORDERED THAT a police officer with (police service) · and (other person) may enter (place or premises) , using force if necessary, in order to search for the missing person. This Order expires on (date and time) . (Justice of the Peace) Form 5 Emergency Access Demand Section 4, Missing Persons Act To: (name) (address) (name of missing person) , born on (date of birth) , has been reported as a missing person to the (police service) that is conducting a non‑criminal investigation into the missing person’s whereabouts, case number . Based on the investigation and information received thus far, · the investigating officer has reasonable grounds to believe that the emergency circumstances described in section 4 of the Missing Persons Act apply, · the records requested fall within those available to police in emergency circumstances under section 4 of the Missing Persons Act , and · you have been identified as a holder of records that may assist in the location of this missing person. By the authority of the Missing Persons Act cited above, you are hereby compelled to produce copies of the following records within 12 hours of service of this demand to (rank) (name) of the (service) who may be contacted by telephone or text at , or by email at : [Remove any listed records or information that are not needed.] · the following records of information requested in accordance with section 4 of the Missing Persons Act , and in particular, _________________________ · records containing contact information or identification, and in particular, · ____________________________________________ · information contained in your client or employee file, and in particular, (optional) ___________________________ · telephone, internet and other electronic communication records, including · ____________________________________________ · wireless signals indicating the location of the device, and in particular, (optional) _________________________ · cellular telephone records from (date) to (date) , and in particular, (optional) _______________________ · incoming and outgoing text messaging or other instant messaging records from (date) to (date) , and in particular, (optional) _________________________________ · browsing history records from (date) to (date) , and in particular, (optional) ______________ · online account activity information from (date) to (date) , and in particular, (optional) ______________ · global positioning system tracking records, and in particular, · ____________________________________________ · from (date) to (date) , and in particular, (optional) ____________________________________ · records containing employment information indicating · when the missing person was last seen or heard from, and in particular, (optional) _________________________ · when, where and how the missing person was paid, and in particular, (optional) ___________________________ · records containing health information indicating · hospital admission or interaction with health services from (date) to (date) , and in particular, (optional) ___________________________________ · date, time and reason for hospital admission or interaction with health services during the stated period, and in particular, (optional) ___________________________________ · records containing school attendance information from (date) to (date) , and in particular, (optional) _______________________________________ · records containing financial information indicating · credit card usage from (date) to (date) ( where, when and for what purpose used ), and in particular, (optional) ___________________________________ · recent access to bank accounts (where, when and for what purpose the account was accessed) , and in particular, (optional) ___________________________________ Dated this day of , 20 Signed Printed Name of Investigating Police Officer Rank Name of Police Service Address Pursuant to the Missing Persons Act [SA 2011, s4(3)], a person who has been served with a copy of this demand shall make the records available or provide copies of the records to the police service within the time specified in the demand. Pursuant to the Missing Persons Act [SA 2011, s7(1)], any information or records collected under the Act by a police service are confidential and may not be disclosed except in accordance with section 7 of the Act and the regulations. Pursuant to the Missing Persons Regulation [AR 151/2012, s7] information or records collected under the Act (a) are, when the missing person has been safely located, to be disposed of within 90 days of the locating of the missing person, (b) may be retained if the missing person is not found or if the missing person is found dead, or (c) may be retained if any further investigations arise or are likely to arise regarding the disappearance of the missing person until any and all investigations are concluded. Form 6 Application for an Order to Comply with Demand Section 5, Missing Persons Act Docket # In the Alberta Court of Justice In the matter of an application under section 5 of the Missing Persons Act Regarding the Missing Person (name of missing person) Application [Remove any portions of the proposed application that are not needed.] 1 My name is (name of applicant) and I am a member of (police service) that is conducting a non-criminal investigation into the whereabouts of the named missing person. 2 The named person has not been in contact with those persons who would likely be in contact with that person. 3 The named person’s whereabouts are unknown despite reasonable efforts to locate the person. 4 The named person’s safety and welfare are feared for given the person’s physical or mental capabilities or the circumstances surrounding the person’s absence. 5 I am applying for an order · compelling (name of person) to comply with the demand made under section 4 of the Missing Persons Act to provide the records specified in that demand, a copy of which is attached. · for costs of this application. Affidavit [Remove any portions of the proposed Affidavit that are not needed.] 6 In support of my application, I make oath/affirm and say that · I believe the records demanded are in the possession or under the control of _____________ named in the demand, · the investigative steps undertaken to date include the following: __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ · I request that the following additional information be considered in support of my application: __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ · I require the order in aid of investigating the whereabouts of the missing person. · the demand under section 4 of the Missing Persons Act was effected by (method) on (date) . SWORN/AFFIRMED BEFORE ME at (city or town) in the Province of Alberta on (yyyy/mm/dd) (Applicant’s signature) (Justice of the Peace or Commissioner for Oaths) Form 7 Order to Comply with Demand Section 5, Missing Persons Act Docket # In the Alberta Court of Justice In the matter of an application under section 5(1) of the Missing Persons Act Regarding the Missing Person (name of missing person) Order regarding records Heard by (name of Justice of the Peace) , a Justice of the Peace on (date) , 20 . (name of applicant) , member of (police service) , has applied for an order to comply with a demand requiring production of copies of records that may be of assistance in investigating the whereabouts of the missing person. On being satisfied that · _____________ is a missing person under the Act, · the police service is conducting a non‑criminal investigation into the whereabouts of the missing person, · the applicant made a demand under section 4 of the Missing Person’s Act that was not fulfilled, and · the applicant has a reasonable belief that the requested records will assist with the investigation, IT IS ORDERED THAT: [Remove any portions of the proposed Order that are not needed.] Copies of the following records containing information related to · the missing person, · (name of individual) in whose company the missing person may be or may have been, in whoever’s possession the records may be, shall be produced to (police service) : · records containing contact information or identification, and in particular, · ____________________________________________ · information contained in your client or employee file, and in particular, (optional) ___________________________ · telephone, internet and other electronic communication records, including · ____________________________________________ · wireless signals indicating the location of the device, and in particular, (optional) _________________________ · cellular telephone records from (date) to (date) , and in particular, (optional) _______________________ · incoming and outgoing text messaging or other instant messaging records from (date) to (date) , and in particular, (optional) ___________________________ · browsing history records from (date) to (date) , and in particular, (optional) ________________________ · online account activity information from (date) to (date) , and in particular, (optional) ______________________________________________ · global positioning system tracking records, and in particular, · ______________________________________________ · from (date) to (date) , and in particular, (optional) _____________________________________ · records containing employment information indicating · when the missing person was last seen or heard from, and in particular, (optional) __________________________ · when, where and how the missing person was paid, and in particular, (optional) ____________________________ · records containing health information indicating · hospital admission or interaction with health services from (date) to (date) , and in particular, (optional) _____________________________________ · date, time and reason for hospital admission or interaction with health services during the stated period, and in particular, (optional) ____________________________ · records containing school attendance information from (date) to (date) , and in particular, (optional) _________________________________________ · records containing financial information indicating · credit card usage from (date) to (date) (where, when and for what purpose used) , and in particular, (optional) _____________________________ · recent access to bank accounts (where, when and for what purpose the account was accessed) , and in particular, (optional) ______________________________________ · (records prescribed by regulation) · (address costs) Compliance with this Order is required within 48 hours of service, or before (date and time) . This Order expires on _____________________. Dated this day of , 20 Signed Printed Name of Police Officer Rank Name of Police Service Address Pursuant to the Missing Persons Act [SA 2011, s7(1)], any information or records collected under the Act by a police service are confidential and may not be disclosed except in accordance with section 7 of the Act and the regulations. Pursuant to the Missing Persons Regulation [AR 151/2012, s4.1(1)] where this Order requires a person to provide records or copies of records, the records or copies of the records shall either (a) be provided to the police service, or (b) if it is not possible for all requested records to be provided, the available records shall be provided together with a time estimate for the provision of the remaining records. Pursuant to the Missing Persons Regulation [AR 151/2012, s7] information or records collected under the Act (a) are, when the missing person has been safely located, to be disposed of within 90 days of the locating of the missing person, (b) may be retained if the missing person is not found or if the missing person is found dead, or (c) may be retained if any further investigations arise or are likely to arise regarding the disappearance of the missing person until any and all investigations are concluded. Form 8 Application for Disclosure of Information Section 7, Missing Persons Act Regarding the Missing Person (name of missing person) 1 I am the (parent or guardian) of (name of missing person) . 2 I am applying to (police service) for disclosure of any information collected during the course of its investigation into the whereabouts of (name of missing person) , and in particular, (optional) ______________________. 3 The period of time for which I am asking for disclosure of the records is (date) to (date) . 4 I am applying for disclosure of this information so that I may know information as to the whereabouts and activities of (name of missing person) during the time that (name of missing person) was a missing person, the circumstances that led (name of missing person) to be a missing person, and also with whom (name of missing person) was or may have been in contact with during the time that (name of missing person) was a missing person, in order to take steps to protect the safety of (name of missing person) in future. Dated at , Alberta, this day of , 20 . Name of Applicant - please print in block letters Signature of Applicant Address (street address) (municipality) (province) (postal code) Telephone Number (daytime) - ( ) (evening) - ( ) Fax Number - ( ) Email Address AR 151/2012 Sched;76/2023