July 5, 2024 Bulk Haulage Regulations–amendment
N.S. Reg. 133/2024
Nova Scotia — Gazette
In force date of regulations: As of November 28, 2023*, the date a regulation comes into force is determined by subsection 3(6) of the Regulations Act. A regulation comes into force on the date it is filed unless the regulation states that it comes into force on a later date, or the Act that the regulation is made under authorizes the regulation to come into force on a date earlier than the date it was filed or authorizes another method of coming into force. *Date that subsections 3(4) and (5) of
Chapter 54 of the Acts of 2022,
An Act to Amend
Chapter 393 of the Revised Statutes, 1989, the Regulations Act, were proclaimed in force. Volume 48, No. 15 July 26, 2024
Part II Halifax, Nova Scotia Regulations under the Regulations Act Published by Authority Contents Act Reg. No. Page Dairy Industry Act Bulk Haulage Regulations–amendment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134/2024 328
Schedule 3–Grading, Packaging and Sale of Dairy Products Regulations–amendment . . 138/2024 352 Municipal Elections Act Municipal Elections Act Forms–amendment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135/2024 330 Petroleum Products Pricing Act Prescribed Petroleum Products Prices (dispensed from publication) . . . . . . . . . . . . . . . . . 133/2024 328 Prescribed Petroleum Products Prices (dispensed from publication) . . . . . . . . . . . . . . . . . 136/2024 347 Residential Tenancies Act Proclamation of amendments to Act, S. 17, S.N.S. 2021, c. 36–S. 10 and 11 . . . . . . . . . . 139/2024 353 Residential Tenancies Regulations–amendment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140/2024 354 Utility and Review Board Act Conseil scolaire Rules–replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137/2024 347 327
N.S. Reg. 133/2024 - 134/2024 Royal Gazette
Part II - Regulations Vol. 48, No. 15 N.S. Reg. 133/2024 Made: July 4, 2024 Filed: July 4, 2024 Prescribed Petroleum Products Prices Order dated July 4, 2024 made by the Nova Scotia Utility and Review Board pursuant to
Section 14 of the Petroleum Products Pricing Act and Sections 16 to 19 of the Petroleum Products Pricing Regulations [Please note: Prescribed Petroleum Products Prices filed with the Office of the Registrar of Regulations on and after January 23, 2023, will no longer be published in the Royal Gazette
Part II. Publication of the Prescribed Petroleum Products Prices has been dispensed with by order of the Attorney General dated January 23, 2023, and published on page 63 of the February 10, 2023, issue of the Royal Gazette
Part II. Current and historical Prescribed Petroleum Products Prices are available for inspection in person at the Office of the Registrar of Regulations and can be viewed on the Nova Scotia Utility and Review Board’s website at the following address: https://nsuarb.novascotia.ca/mandates/gasoline-diesel-pricing. N.S. Reg. 134/2024 Made: June 20, 2024 Approved: July 3, 2024 Filed: July 5, 2024 Bulk Haulage Regulations–amendment Order dated July 3, 2024 Amendment to regulations made by the Dairy Farmers of Nova Scotia and approved by the Natural Products Marketing Council pursuant to clause 15(1)(
b) of the Dairy Industry Act Dairy Farmers of Nova Scotia Amendment to the Bulk Haulage Regulations made under the Dairy Industry Act I certify that on June 20, 2024, the Dairy Farmers of Nova Scotia, pursuant to clause 15(1)(
b) of
Chapter 24 of the Acts of 2000, the Dairy Industry Act, carried a motion to amend the Bulk Haulage Regulations, N.S. Reg. 23/2003, made by the Dairy Farmers of Nova Scotia on July 17, 2002, and approved by the Natural Products Marketing Council on August 13, 2002, in the manner set forth in the attached
Schedule “A”, effective on and after August 1, 2024. Signed at Bible Hill, in the County of Colchester, Nova Scotia on July 3, 2024. Dairy Farmers of Nova Scotia per: sgd. Ann Landers Ann Landers General Manager 328
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Part II - Regulations Vol. 48, No. 15 Approved by the Natural Products Marketing Council at Bible Hill, in the County of Colchester, Nova Scotia, on July 3, 2024. Natural Products Marketing Council per: sgd. Danielle Dorn Kouwenberg Danielle Dorn Kouwenberg Manager
Schedule “A” Amendment to the Bulk Haulage Regulations made by the Dairy Farmers of Nova Scotia pursuant to clause 15(1)(
b) of
Chapter 24 of the Acts of 2000, the Dairy Industry Act
Section 7 of the Bulk Haulage Regulations, N.S. Reg. 23/2003, made by the Dairy Farmers of Nova Scotia on July 17, 2002, and approved by the Natural Products Marketing Council on August 13, 2002, is amended by repealing clause (
a) and substituting the following clause: (
a) for farm milk pick-up that occurs on a set
schedule of every second day: Transporter Maximum Rate/100 L Fisher Transport Limited $3.21 Burghardt Transport Limited $3.66 329
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Part II - Regulations Vol. 48, No. 15 N.S. Reg. 135/2024 Made: July 5, 2024 Filed: July 5, 2024 Municipal Elections Act Forms–amendment Order dated July 5, 2024 Amendment to regulations made by the Minister of Municipal Affairs and Housing pursuant to
Section 167 of the Municipal Elections Act In the matter of
Section 167 of
Chapter 300 of the Revised Statutes of Nova Scotia, 1989, the Municipal Elections Act -and- In the matter of an amendment to the regulations respecting Municipal Elections Act forms made by the Minister of Municipal Affairs and Housing Order I, John Lohr, Minister of Municipal Affairs and Housing for the Province of Nova Scotia, pursuant to
Section 167 of
Chapter 300 of the Revised Statutes of Nova Scotia, 1989, the Municipal Elections Act, hereby amend the regulations respecting Municipal Elections Act forms, N.S. Reg. 84/1997, made by the Governor in Council by Order in Council 97-469 dated July 15, 1997, by (
a) repealing Forms 3, 9 and 11 and [substituting] the attached substituting Forms 3, 9 and 11; (
b) repealing Form 11A; (
c) repealing Form 11B and substituting the attached Form 11B; (
d) repealing Form 11C; (
e) repealing Forms 14, 15, 16, 19, 20, 22, 27 and 30 and substituting the attached Forms 14, 15, 16, 19, 20, 22, 27 and 30; (
f) repealing Form 31A; and (
g) repealing Forms 34A, 39, 40, 41, 44 and 45 and substituting the attached Forms 34A, 39, 40, 41, 44 and 45. This order is effective on and after the date it is filed. Dated and made July 5, 2024, at Halifax Regional Municipality, Province of Nova Scotia. sgd. John Lohr Honourable John Lohr Minister of Municipal Affairs and Housing 330
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Part II - Regulations Vol. 48, No. 15 Form 3: Certificate in Respect to Charges that are Liens/Taxes (Sections 17, 44, 45) I certify that as of the ______________ day of ____________________, ______, (nomination day) ___________________________________ (name of candidate) has fully paid all (
i) the charges that are liens on property that are due, (ii) all the municipal taxes that are due, and (iii) all instalments or interim payments that are due as of nomination day have been paid to the Town/Municipality/ Regional Municipality of ______________________ from the candidate. ______________________________________ Clerk, Treasurer, Collector or other official having knowledge of the facts ________________________________________________________________ Form 9: Oath or Affirmation of Person Applying for Amendment of the List of Electors (Section 35, 36) I ________________________________ of ______________________________, swear (or solemnly affirm) (name) (address) that I believe that ___________________________________ of _____________________________________, (name) (address) registered on the list of electors for Polling Station Number ________ in Polling District Number ________, in the Town/Municipality/Regional Municipality of ____________________________________ (the “Municipality”) should not be on the list because (place a check mark next to the applicable statement) _______ the person does not reside at the address shown; _______ the person is not the full age of eighteen years and will not be as of the first advance polling day; _______ the person is not a Canadian citizen or will not be as of the first advance polling day; _______ the person has not been or will not have been ordinarily resident in: • the province of Nova Scotia for six (6) months; and • the Municipality. as of the first advance polling day in this election; _______ the person is dead.
Sworn (or affirmed) at ____________________ in the _____________ of _________________________ this _______ day of ______________________, _________, before me _________________________________ _______________________________ Revising Officer Applicant 331
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Part II - Regulations Vol. 48, No. 15 Form 11: Nomination Paper (Mayor or Other Council Member) (Section 44) We, the qualified electors whose names appear on the amended list of electors of the Town/Municipality/ Regional Municipality of ____________________________________________ , nominate__________________________________________________________________ of (name) ____________________________________________________________________________, (civic address) _________________________________________ _______________________________ (postal code) ____________________________________________________________________________ (include mailing address if different than civic address ) as a candidate for the office of _______________________________ for the election to be held on the _______________ day of ______________________________, __________________.
Name (please print) Civic Address Signature ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ Note: 1.
These electors must be qualified to vote at the election of the candidate. At least 5 qualified electors must sign the nomination form. 2. Nomination forms are open for inspection by the public once signed by the Returning Officer. Consent and Oath or Affirmation of Candidate I solemnly swear (or affirm) that: 1. I (The candidate), ________________________________________, consent (
s) to the nomination. (name as it should appear on the ballot paper) 2. I am (The candidate is) a Canadian citizen. 3. I am (The candidate is) of the full age of eighteen years. 4. I have (The candidate has) been ordinarily a resident in the Town/Municipality/Regional Municipality of ____________________________________________, ( or in an area annexed to the Town/Municipality/ Regional Municipality), for a period of six months preceding nomination day and I intend (the candidate 332
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Part II - Regulations Vol. 48, No. 15 intends) to continue to so reside. 5. I am (The candidate is) not indebted to the Town/Municipality/Regional Municipality of ___________________________ for any charges that are liens on property or taxes, or all instalments or interim payments that are due as of nomination day have been paid, and a certificate from the __________________________________ to this effect is attached. 6. I have (The candidate has) not been convicted of bribery or of committing a corrupt practice under the Municipal Elections Act within the five years preceding nomination day. 7.
I have (The candidate has) read the Sections of the Municipal Elections Act related to persons disqualified to vote, to be nominated or to serve on a council and none of the reasons for disqualification listed in those Sections apply to me (the candidate). 8. I have (The candidate has) read and I understand (the candidate understands) the provisions of the Municipal Elections Act related to the requirement to take a leave of absence if I am (the candidate is) an employee of the Town/Municipality/Regional Municipality within the meaning of those provisions. 9.
I understand (the candidate understands) that a list of electors is permitted to be used for election purposes and for no other purposes and that it is not to be open for inspection, disposed of or sold. 10. I understand (the candidate understands) that, within 7 days following the election, all copies of the list of electors in my (the candidate’
s) possession must be returned and all electronic copies must be returned, destroyed or deleted. I further understand (The candidate understands) that if I fail (the candidate fails) to do so, I forfeit (the candidate forfeits) any candidate’s deposit to which I (the candidate) might otherwise be entitled to receive. 11. I (The candidate) will accept the office of _________________________________ if elected. 12. I appoint (The candidate appoints) _______________________________________ of _____________________ as my (the candidate’
s) official agent under the Municipal Elections Act. Sworn (or affirmed) at _________________________ in the County of ______________________________ this ___________ day of _______________________ _______________, before me ___________________________________ _______________________________ Authorized Administrator of Oath Candidate (or Agent if authorized (See
Section 146) and the authorization is attached) Receipt Received from the above-named candidate or from the candidate’s agent on the candidate’s behalf a completed nomination paper and the sum of _____________ in legal tender or a certified cheque or money order made payable to the Town/Municipality/Regional Municipality of __________________________ as a deposit pursuant to the Municipal Elections Act. Dated at ________________________ this__________ day of ___________________, _____. _______________________________ Returning Officer 333
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Part II - Regulations Vol. 48, No. 15 Form 11B: Nomination Paper (Conseil scolaire acadien provincial) (Section 44) (Section 13, Education (CSAP) Act) District__________________________________________ (name) We, the qualified electors whose names appear on the amended list of electors for the municipality shown opposite each name, nominate: _________________________________ of (name) ____________________________________________________________________________, (civic address) __________________________________________ _______________________________ (postal code) ____________________________________________________________________________ (include mailing address if different than civic address) as a candidate for the office of ____________________________ for the election to be held on the __________ day of ______________________________, __________________. (Note: Nominators to sign below and also to sign “Statement of Nominators”.) Name (please print) Civic Address Municipality _____________________ ______________________________ ______________________ ______________________ Signature Name (please print) Civic Address Municipality _____________________ ______________________________ ______________________ ______________________ Signature Name (please print) Civic Address Municipality _____________________ ______________________________ ______________________ ______________________ Signature Name (please print) Civic Address Municipality _____________________ ______________________________ ______________________ ______________________ Signature 334
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Part II - Regulations Vol. 48, No. 15 Name (please print) Civic Address Municipality _____________________ ______________________________ ______________________ ______________________ Signature Note: 1. These electors must be qualified to vote at the election of the CSAP candidate. 2. Nomination forms are open for inspection by the public once signed by the Returning Officer.
Statement of Nominators Under the Education (CSAP) Act, only an “entitled person” may nominate a candidate for election as a member of the Conseil scolaire acadien provincial. “Entitled person” is defined to mean an entitled parent or a person who, not being an entitled parent, would be an entitled parent if the person were a parent. Under the Education (CSAP) Act, an “entitled parent” is defined to mean a person who is a Canadian citizen AND (
a) whose first language learned and still understood is French; OR (
b) who received their primary school instruction in Canada in a French-first-language program; OR (
c) who is the parent of a child who has received or is receiving primary or secondary school instruction in Canada in a French-first-language program (note that the definition of “parent” does not include a guardian or person acting in loco parentis to a child).
I state that I am an “entitled person” within the meaning of this definition. ___________________________________ _______________________________ Name (please print) Signature ___________________________________ _______________________________ Name (please print) Signature ___________________________________ _______________________________ Name (please print) Signature ___________________________________ _______________________________ Name (please print) Signature ___________________________________ _______________________________ Name (please print) Signature Statement of Candidate Under the Education (CSAP) Act, only an “entitled person” may be a member of the Conseil scolaire acadien provincial. “Entitled person” is defined to mean an entitled parent or a person who, not being an entitled parent, would be an entitled parent if the person were a parent. 335
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Part II - Regulations Vol. 48, No. 15 Under the Education (CSAP) Act, an “entitled parent” is defined to mean a person who is a Canadian citizen AND (
a) whose first language learned and still understood is French; OR (
b) who received their primary school instruction in Canada in a French-first-language program; OR (
c) who is the parent of a child who has received or is receiving primary or secondary school instruction in Canada in a French-first-language program (note that the definition of “parent” does not include a guardian or person acting in loco parentis to a child). I state that I am an “entitled person” within the meaning of this definition. ____________________________________ Candidate (Note: This Statement must be signed by the candidate; it cannot be signed by the official agent.) Consent and Oath or Affirmation of Candidate I swear (or solemnly affirm) that: 1. I (The candidate), _______________________________________, consent (
s) to the nomination. (name as it should appear on the ballot paper) 2. I am (The candidate is) a Canadian citizen. 3. I am (The candidate is) of the full age of eighteen years. 4. I have (The candidate has) been ordinarily resident in the Province of Nova Scotia for a period of six months preceding nomination day, and continue(
s) to so reside. 5. I have (The candidate has) not been convicted of any corrupt practice or bribery under the Municipal Elections Act within the ten years preceding nomination day. 6. I have (The candidate has) read and I understand (the candidate understands) all the provisions of the Education (CSAP) Act related to the disqualifications of a person from being nominated or to serve as a member of the Conseil scolaire acadien provincial and none of those reasons for disqualification apply to me (the candidate). 7.
I understand (The candidate understands) that a list of electors is permitted to be used for election purposes and for no other purposes and that it is not to be open for inspection, disposed of or sold. 8. I understand (The candidate understands) that, within 7 days following the election, all copies of the list of electors in my (the candidate’
s) possession must be returned and all electronic copies must be returned, destroyed or deleted. I further understand (The candidate understands) that if I fail (the candidate fails) to do so, I forfeit (the candidate forfeits) any candidate’s deposit to which I (the candidate) might otherwise be entitled to receive. 9. I (The candidate) will accept the office of the member of the Conseil scolaire acadien provincial if elected. 336
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Part II - Regulations Vol. 48, No. 15 10. I (The candidate) appoint(s) ________________________ of ______________________________ (name) (address) as my (the candidate’
s) official agent under the Municipal Elections Act. Sworn (or affirmed) at _________________________ in the County of ______________________________ this ___________ day of _______________________ _______________, before me ___________________________________ _____________________________________ Authorized Administrator of Oath Candidate (or Agent if authorized (Refer to
Section 146) and the authorization is attached) Receipt Received from the above-named candidate or from the candidate’s agent on the candidate’s behalf a completed nomination paper and the sum of __________________________ in legal tender or a certified cheque or money order made payable to the Town/Municipality/Regional Municipality of _____________________________ as a deposit pursuant to the Municipal Elections Act.
Dated at ______________________ this__________ day of _____________________, _____. _______________________________ Returning Officer (A translation of this form is available in French.) ________________________________________________________________ Form 14: Format of Poll Book (Section 68) 1. The cover of the poll book shall bear the subject of the election, the polling district number, and the date of ordinary polling day. 2. The first page of the poll book shall contain Form 2. 3. The second page of the poll book shall contain Form 16. 4.
Form 24 shall be on the third page, then Forms 25, 26, 26A, 27, 28, and 29 shall follow. 5. Then shall follow twelve pages of Form 30. 6. Then shall follow three pages of Form 31. 7. Then shall follow two pages of Form 31B. 8. Then shall follow three pages of Form 32. 9. Then shall follow eight pages of Form 33 or 34 for each matter for which a poll was granted. 10. Then shall follow one page of Form 34A for each CSAP office to be elected. 337
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Part II - Regulations Vol. 48, No. 15 11. Then shall follow eight pages of Form 35 for each matter for which a poll was granted. 12. Then shall follow two pages of Form 46, and the back cover. This format may be varied by altering the number of copies of forms required to be included to suit the circumstances of the election.
Additional or loose copies of some forms also may be used; these should be added to the poll book at the end of voting. ________________________________________________________________ Form 15: Appointment of Agent (Polling Station) (Section 71) I, the undersigned, candidate (or the official agent of ____________________, (candidate’s name) a candidate) for__________________________, (office) appoint the following as my (the candidate’
s) agent with authority to represent me (the candidate) in the manner provided by the Municipal Elections Act at Polling Station Number ________ for the election being held on _______________, _____. ______________________________ ___________________________________ (name of agent) (address of agent) Dated at _____________ Nova Scotia, this ______ day of _____________, ____. _______________________________________ Signature of candidate or of official agent ________________________________________________________________ Form 16: Oath or Affirmation of Agent Representing a Candidate (Polling Station) (Section 69) I ______________________ the undersigned, swear (or solemnly affirm) that, at the election to be held in the Town/Municipality/Regional Municipality of __________ on the _____ day of ___________, _____, I will not attempt, in any way, unlawfully to ascertain the candidate or candidates for whom a voter has voted and will not in any way aid in the unlawful discovery of the same, and that I will keep secret all knowledge which may come to me of the persons for whom any voter has voted.
Candidate’s Name Agent’s Signature Sworn (or affirmed) at_____________________ in the County of ____________ this ______ day of ________________, ___________, before me ________________________________ Deputy Returning Officer 338
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Part II - Regulations Vol. 48, No. 15 Form 19: Transfer Certificate (Polling Station) (Section 73) I certify that the elector named below is entitled under
Section 73 of the Municipal Elections Act to a transfer certificate permitting the elector to transfer their vote from Polling Station Number __________ to Polling Station Number ___________ and I grant this certificate so authorizing the elector. _______________________________ _____________________________________ Name of Elector Address Dated this ______ day of ________________, _____. ______________________________ Returning Officer or Assistant Returning Officer Note: Complete in triplicate. ________________________________________________________________ Form 20: Transfer Certificate (Polling District) (Section 73) I certify that the elector named below is entitled under
Section 73 of the Municipal Elections Act to a transfer certificate permitting the elector to transfer their vote from Polling Station Number _______ in Polling District Number __________ to Polling Station Number __________ in Polling District Number ____________, and I grant this certificate so authorizing the elector to vote for the election of _______________________________ _____________________________ (specify mayor, councillor(s), CSAP, plebiscite). _______________________________ _____________________________________ Name of Elector Address Dated this _____ day of _____________, ______. _______________________________________ Returning Officer or Assistant Returning Officer Note: Complete in triplicate. ________________________________________________________________ Form 22: Number ____, Proxy Paper (Section 76) (NOTE: A Proxy Voter can vote only on Ordinary Polling Day.
A Proxy Voter cannot vote at any Advance Poll) TO: The Deputy Returning Officer Polling Station Number ________________ 339
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Part II - Regulations Vol. 48, No. 15 Polling District of _________________ I certify that: _________________________________________________________________________ (name of elector) of_______________________________________________________________________ (address of elector) being number __________ on the list of electors for the above polling station may vote by proxy by the elector’s proxy voter, _________________________________________________________________________ (name of proxy voter) of_______________________________________________________________________ (address of proxy voter) Dated at _________________ this ______ day of ___________________________, _______. ______________________________ Returning Officer ________________________________________________________________ Form 27: Oath or Affirmation of Interpreter (Section 87) You swear (or solemnly affirm) that you shall well and truly interpret the questions asked of the elector and explanations given to the elector, and the answers and questions of the elector, and that you will keep secret any information so obtained. 340
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Part II - Regulations Vol. 48, No. 15 Form 30: Record of Poll (Section 94) Order of Voting No. on List of Electors/ Certificate of Eligibility Name of Elector (Family Name First) Address of Elector Voted for Mayor Voted for Councillor Voted for CSAP Voted for Other Sworn or Affirmed Refused to Swear or Affirm Transfer Added By Proxy Remarks (e.g., form of oath taken) Use a Check Mark 341
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Part II - Regulations Vol. 48, No. 15 Form 34A: Statement of Poll to be Completed when Conseil scolaire acadien provincial Ballots to be Transferred for Counting (Section 123A) Municipality: Polling District: Polling Station No.: Election for: Date: 1. Number of blank ballots received from Returning Officer 2. Add number of ballots from Advance Poll (if any) 3. TOTAL BALLOTS TO BE ACCOUNTED FOR * 4. Number of ballots taken from the polling station (if any) 5. Number of ballots missing (if any) 6. Number of unused ballots 7. Number of cancelled ballots (ones not placed in the ballot box) 8.
Number of ballots cast at polling station for this office (ones placed in the ballot box) Ë 9. TOTAL BALLOTS ACCOUNTED FOR * *Note: Lines 3 and 9 must balance 10. TOTAL BALLOTS BEING TRANSFERRED Ë ËNote: Lines 8 and 10 must balance Dated at _______________ , this ____ day of ______________ , _______.
Approved: We certify that the above statement is correct ___________________________ ______________________________ Deputy Returning Officer ___________________________ ______________________________ Poll Clerk ________________________________________________________________ Form 39: Council Member’s Oath of Allegiance and of Office (Section 147) I, ____________________________, swear (or solemnly affirm) that I will be faithful and bear true allegiance to His Majesty King Charles the Third, His heirs and successors according to law; (the name of and reference to the sovereign to be changed as occasion requires.) And that I am duly qualified as required by law for the office of ________________ of the ________________ of ________________; And that I will truly, faithfully and impartially execute the duties of the office to which I have been elected to the best of my knowledge and ability; And that I have not received and will not receive any payment or reward or promise thereof for the exercise of any partiality or other undue execution of the duties of my office. 342
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Part II - Regulations Vol. 48, No. 15 Sworn (or affirmed) at ________________ in the County of _____________________ this _____ day of ____________________, _______, before me __________________________________ Judge, Justice of the Peace (or for council members, also Mayor, Warden or Clerk) ________________________________________________________________ Form 40: Candidate’s Campaign Contributions Disclosure Statement (Sections 49A and 49B) Name of Candidate: ____________________________________________________________ Name of Agent: ________________________________________________________________ Date of Election: ______________ Municipality/CSAP: __________________________ 9 I received no contributions from a contributor that totalled more than $50.00 during the period since the previous election.
OR 9 I received the following contributions from a contributor that totalled more than $50.00 during the period since the previous election.
List of contributors (see note below): Contributor Civic Address Contributions ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ Note: Insert full name of contributor and residential or business address. Use street address, not postal address.
Contributions must be shown for every contributor whose contributions totalled more than $50.00 since the most recent election. I, _________________________________, a candidate in the municipal/CSAP election on __________________ (date), certify that the foregoing statement of disclosure is a true and complete disclosure of all contributions made to me and to my official agent as required by Sections 49A and 49B of the Municipal Elections Act. _____________________________________ Candidate 343
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Part II - Regulations Vol. 48, No. 15 (To be filed within 60 days after regular polling day with the clerk of the municipality/secretary of CSAP) (A translation of this form is available in French.) ________________________________________________________________ Form 41: Association’s Campaign Contributions Disclosure Statement (Sections 49A and 49B) Name of Association: ____________________________________________________________ Name of agent: ________________________________________________________________ Name of candidate supported: _____________________________________________________ Date of election: _____________ Municipality/CSAP: ___________________________ 9 The above-named candidate received no contributions from a contributor that totalled more than $50.00 during the period since the previous election.
OR 9 The candidate received the following contributions from a contributor that totalled more than $50.00 during the period since the previous election.
List of contributors (see note below): Contributor Civic Address Contributions ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ ________________________ _______________________ _______________________ Note: Insert full name of contributor and residential or business address. Use street address, not postal address.
Contributions must be shown for every contributor whose contributions totalled more than $50.00 since the most recent election.
I, _______________________________, the appointed agent of _________________________ (name of association) in the municipal/CSAP election on __________________ (date), certify that the foregoing statement of disclosure is a true and complete disclosure of all contributions made to me as agent of the said association as required by Sections 49A and 49B of the Municipal Elections Act. _____________________________________ Agent of Association (To be filed within 60 days after regular polling day with the clerk of the municipality/secretary of CSAP) (A translation of this form is available in French.) 344
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Part II - Regulations Vol. 48, No. 15 Form 44: Statement of Poll, Consolidated Count of Conseil scolaire acadien provincial Ballots (One Member to be Elected from the CSAP Electoral District) (Section 123A) (For use when the ballots from polls with fewer than 10 votes for a CSAP office are counted by a counting officer) CSAP Electoral District Number of Polls to be Counted (# of envelopes to be opened and counted) 1. Total Number of Ballots to be Counted (from endorsements on each envelope from each polling station) * 2. Number of Rejected Ballot Papers 3. Number of Ballot Papers Counted and Accepted 4.
Number of Ballot Papers Missing (if any) (#1 minus #3) 5. Additional Ballot Papers (if any) (#3 minus #1) 6. Total Ballots to be Accounted for * (Note: Lines 1 and 6 must balance.) 7. Number of Ballots counted for Number of Ballots counted for Number of Ballots counted for Number of Ballots counted for Number of Ballots counted for 8. TOTAL BALLOTS ACCOUNTED FOR * (Note: Lines 6 and 8 must balance.) Dated at _________________, this _______ day of _____________, ______. Approved I certify that the above statement is correct __________________________________ Counting Officer 345
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Part II - Regulations Vol. 48, No. 15 Form 45: Statement of Poll, Consolidated Count of Conseil scolaire acadien provincial Ballots (More than One Member to be Elected from the CSAP Electoral District) (Section 123A) (For use when the ballots from polls with fewer than 10 votes for a CSAP office are counted by a counting officer) CSAP Electoral District Number of Polls to be Counted (# of envelopes to be opened and counted) 1. Total Number of Ballots to be Counted (from endorsements on each envelope from each polling station) * 2. Number of Rejected Ballot Papers 3. Number of Ballot Papers Counted and Accepted 4.
Number of Ballot Papers Missing (if any) (#1 minus #3) 5. Additional Ballot Papers (if any) (#3 minus #1) 6. Total Ballots to be Accounted for * (Note: Lines 1 and 6 must balance.) 7 Names of Candidates Number of Ballots (Votes) 8. TOTAL BALLOTS ACCOUNTED FOR * (Note: Lines 6 and 8 must balance.) Dated at _________________, this _______ day of _____________, ______. Approved I certify that the above statement is correct Counting Officer 346
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Part II - Regulations Vol. 48, No. 15 N.S. Reg. 136/2024 Made: July 11, 2024 Filed: July 11, 2024 Prescribed Petroleum Products Prices Order dated July 11, 2024 made by the Nova Scotia Utility and Review Board pursuant to
Section 14 of the Petroleum Products Pricing Act and Sections 16 to 19 of the Petroleum Products Pricing Regulations [Please note: Prescribed Petroleum Products Prices filed with the Office of the Registrar of Regulations on and after January 23, 2023, will no longer be published in the Royal Gazette
Part II. Publication of the Prescribed Petroleum Products Prices has been dispensed with by order of the Attorney General dated January 23, 2023, and published on page 63 of the February 10, 2023, issue of the Royal Gazette
Part II. Current and historical Prescribed Petroleum Products Prices are available for inspection in person at the Office of the Registrar of Regulations and can be viewed on the Nova Scotia Utility and Review Board’s website at the following address: https://nsuarb.novascotia.ca/mandates/gasoline-diesel-pricing.] N.S. Reg. 137/2024 Made: June 27, 2024 Filed: July 12, 2024 Conseil scolaire Rules–replacement Order dated June 27, 2024 Repeal of regulations and regulations made by the Nova Scotia Utility and Review Board pursuant to
Section 12 of the Utility and Review Board Act Order Nova Scotia Utility and Review Board In the matter of the Education (CSAP) Act - and - In the matter of a motion to repeal and replace the School Board Rules with the Conseil scolaire Rules Before: Stephen T. McGrath, K.C., Chair Roland A. Deveau, K.C., Vice Chair Richard J. Melanson, LL.B., Member Jennifer L. Nicholson, CPA, CA, Member Steven Murphy, MBA, P.Eng., Member Julia E. Clark, LL.B., Member Bruce H. Fisher, MPA, CPA, CMA, Member M.
Kathleen McManus, K.C., Ph.D., Member Order At a meeting of the Nova Scotia Utility and Review Board on June 27, 2024, it passed a motion to repeal and replace the School Board Rules, N.S. Reg. 1/[19]99 (November 20, 1998). 347
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Part II - Regulations Vol. 48, No. 15 The Board orders that the School Board Rules, N.S. Reg. 1/[19]99 (November 20, 1998) made under s. 12 of the Utility and Review Board Act, S.N.S. 1992, c. 11, are hereby repealed, and the Conseil scolaire Rules, as set out in
Schedule “A” attached hereto and forming part of this Order, are substituted therefor. Dated at Halifax, Nova Scotia, this 27th day of June, 2024. sgd. Bruce A. Kiley Clerk of the Board
Schedule “A” Conseil scolaire Rules made under
Section 12 of the Utility and Review Board Act S.N.S. 1992, c. 11 Nova Scotia Utility and Review Board Rules of Practice and Procedure Respecting Applications under the Education (CSAP) Act 1 These rules are made pursuant to
Section 12 of the Utility and Review Board Act and apply to applications to the Board under the Education (CSAP) Act. 2 These rules may be cited as the Conseil scolaire Rules. 3 In these rules: (a) “Act” means the Education (CSAP) Act; (b) “Board” means the Nova Scotia Utility and Review Board; (c) “Conseil scolaire” means the Conseil scolaire acadien provincial. 4
(1) An application to the Board under
Section 43 of the Act to confirm the number and boundaries of the electoral districts or to change the number and boundaries of the electoral districts shall be in writing and shall contain the following information: (
a) a brief description of each of the electoral districts including the names of the larger communities, the geographic size, any relevant geographic features, and any factors which establish a particular community of interest in the electoral district; (
b) a table which shows the following information: (
i) the latest available population statistics for each electoral district, (ii) the distribution of the school-age population in the electoral districts, (iii) statistics from the most recent school board election showing the number of electors in each electoral district and the total number of voters, (iv) the percentage of the total number of electors in each electoral district, (
v) the average number of electors per electoral district, 348
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Part II - Regulations Vol. 48, No. 15 (vi) the amount expressed as a number by which the number of electors in each electoral district exceeds or is less than the average number of electors per electoral district, and (vii) the amount expressed as a percentage by which the number of electors per electoral district exceeds or is less than the average number of electors per electoral district.
(2) Where the application is to confirm the number and boundaries of the existing electoral districts, it shall contain reasons why the status quo should remain in place.
(3) Where the application is to change the number or boundaries of the electoral districts, it shall contain the following additional information: (
a) a brief description of each proposed electoral district including the names of the larger communities, the geographic size, any relevant geographic features, and any factors which establish a particular community of interest in the electoral district; (
b) a table which shows the following information: (
i) the latest available population statistics for each proposed electoral district, (ii) the distribution of the school-age population in the proposed electoral districts, (iii) statistics from the most recent school board election showing the number of electors in each proposed electoral district and the total number of voters, (iv) the percentage of the total number of electors in each proposed electoral district, (
v) the average number of electors per electoral district, (vi) the amount expressed as a number by which the number of electors in each electoral district exceeds or is less than the average number of electors per electoral district, and (vii) the amount expressed as a percentage by which the number of electors per electoral district exceeds or is less than the average number of electors per electoral district.
(4) The application shall be accompanied by maps showing: (
a) the boundaries of the existing electoral districts; (
b) the boundaries of the polling districts or wards within each electoral district; (
c) where the application is to change the number or boundaries of the electoral districts, a map showing the boundaries of the proposed electoral districts.
(5) An application shall be signed by the chair and the superintendent of the school board and shall be accompanied by a copy of the minutes of the school board authorizing or directing the making of the application, certified by the secretary of the school board or be a true copy of the minutes.
(6) The application may be in Form A. 5 In addition to the information contained in an application, the Board may require the school board to provide additional information. 349
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Part II - Regulations Vol. 48, No. 15 6
(1) In any application the Board may itself or on the application of any party, request the parties to appear before it for a pre-hearing conference to consider: (
a) the simplification of the issues; (
b) the necessity or desirability of an amendment to the application; (
c) the participation by interested persons; (
d) a request for access to information in the custody or control of any party; (
e) any other matter which may aid in the disposition of the application.
(2) If agreed to by all parties and the Board, a pre-hearing conference may be conducted by telephone. 7 The Board, either upon its own motion, or upon application of any party, may adjourn a hearing from time to time. 8 Hearings may be conducted in an informal manner and need not follow the strict rules of practice and procedure usual in a court of law. 9 The Board, whenever it deems it desirable, may require briefs to be filed by the parties within such time as the Board may prescribe. 10 The Board may destroy any exhibits remaining in its custody at the expiration of six months from the date of the decision, unless the return of those exhibits is requested by the party filing them, provided no appeal or judicial review of the decision has been commenced.
Form A NSUARB- Nova Scotia Utility and Review Board In the matter of: An application pursuant to the Education (CSAP) Act The Conseil scholaire [scolaire] makes application to the Nova Scotia Utility and Review Board to: ( ) confirm the number and boundaries of the electoral districts. ( ) change the number and boundaries of the electoral districts. 1 There are at present ____ electoral districts. 2 The following is a brief outline of each electoral district, including the names of the larger communities, the geographic size, any relevant geographic features, and any factors which establish a particular community of interest in the electoral district: Electoral District 1: Electoral District 2: 350
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Part II - Regulations Vol. 48, No. 15 3 The following table shows the latest population and elector statistics. Electoral District Population School-age Population # of Electors % of Total Electors Amount < or > Average # % Total Population: Total Number of Electors: Average Number of Electors per Electoral District: 4 The number and boundaries of the electoral districts should be confirmed for the following reasons: OR 4 (
a) The following changes to the number and boundaries of the electoral districts are proposed: (
b) The reasons for these proposed changes are as follows: (
c) A brief outline of each proposed electoral district, including the names of the larger communities, the geographic size, any relevant geographic features, and any factors which establish a particular community of interest in the electoral district: Electoral District 1: Electoral District 2: (
d) The following table shows an estimate of the population and voter statistics which will result if the application are [is] approved by the Board: Electoral District Population School-age Population # of Electors % of Total Electors Amount < or > Average # % 351
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Part II - Regulations Vol. 48, No. 15 Total Population: Total Number of Electors: Average Number of Electors per Electoral District: 5 Map(
s) attached showing the boundaries of the electoral districts and the boundaries of the polling districts and/or wards within each electoral district. Dated at , County of , Nova Scotia, this day of Chair Superintendent N.S. Reg. 138/2024 Made: May 6, 2024 Approved: July 9, 2024 Filed: July 16, 2024
Schedule 3–Grading, Packaging and Sale of Dairy Products Regulations–amendment Order dated July 2, 2024 Amendment to regulations made by the Natural Products Marketing Council and approved by the Minister of Agriculture pursuant to
Section 11 of the Dairy Industry Act Natural Products Marketing Council I certify that the Natural Products Marketing Council has consulted with the Dairy Farmers of Nova Scotia and the Processor Association in accordance with
Section 11 of
Chapter 24 of the Acts of 2000, the Dairy Industry Act (“the Act”), and, at a meeting held May 6, 2024, the Council, pursuant to
Section 11 of
Chapter 24 of the Act carried a motion to amend
Schedule 3–Grading, Packaging and Sale of Dairy Products Regulations, N.S. Reg. 200/[19]89, made by the Nova Scotia Dairy Commission on August 11, 1989, in the manner set forth in the attached
Schedule “A”, effective on and after July 16, 2024. Signed at Bible Hill, in the County of Colchester, Nova Scotia, on July 2, 2024. Natural Products Marketing Council per: sgd. Danielle Dorn Kouwenberg Danielle Dorn Kouwenberg Manager ------------------------------------------------------------------------------------------------------ Approved by Greg Morrow, Minister of Agriculture for the Province of Nova Scotia, at Bible Hill, in the County of Colchester, Nova Scotia, on July 9, 2024. sgd. Greg Morrow Honourable Greg Morrow Minister of Agriculture 352
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Part II - Regulations Vol. 48, No. 15
Schedule “A” Amendment to the
Schedule 3–Grading, Packaging and Sale of Dairy Products Regulations made by the Natural Products Marketing Council pursuant to
Section 11 of
Chapter 24 of the Acts of 2000, the Dairy Industry Act Clause 13(
a) of the
Schedule 3–Grading, Packaging and Sale of Dairy Products Regulations, N.S. Reg. 200/[19]89, made by the Nova Scotia Dairy Commission on August 11, 1989, is amended by replacing subclause (vii) with the following: (vii) permitted preservatives, (viii) vitamin D. N.S. Reg. 139/2024 Made: July 16, 2024 Filed: July 16, 2024 Proclamation of amendments to Act, S. 17, S.N.S. 2021, c. 36–S. 10 and 11 Order in Council 2024-280 dated July 16, 2024 Proclamation made by the Governor in Council pursuant to
Section 17 of
An Act to Amend
Chapter 401 of the Revised Statutes, 1989, the Residential Tenancies Act The Governor in Council on the report and recommendation of the Minister responsible for the Residential Tenancies Act dated June 13, 2024, and pursuant to
Section 17 of
Chapter 36 of the Acts of 2021,
An Act to Amend
Chapter 401 of the Revised Statutes, 1989, the Residential Tenancies Act, is pleased to order and declare by proclamation that Sections 10 and 11 of
Chapter 36 of the Acts of 2021,
An Act to Amend
Chapter 401 of the Revised Statutes, 1989, the Residential Tenancies Act, do come into force on and not before August 1, 2024. L.S. Canada Province of Nova Scotia Charles the Third, by the Grace of God, King of Canada and His Other Realms and Territories, Head of the Commonwealth. To all [to] whom these presents shall come, or whom the same may in any wise concern, Greeting! A Proclamation
Whereas in and by
Section 17 of
Chapter 36 of the Acts of 2021,
An Act to Amend
Chapter 401 of the Revised Statutes, 1989, the Residential Tenancies Act, it is enacted as follows: 17
Section 2, subsection 3(1), Sections 4 and 5, subsection 6(1) and Sections 8 to 13 come into force on such day as the Governor in Council orders and declares by proclamation. 353
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Part II - Regulations Vol. 48, No. 15 And
Whereas it is deemed expedient that Sections 10 and 11 of
Chapter 36 of the Acts of 2021,
An Act to Amend
Chapter 401 of the Revised Statutes, 1989, the Residential Tenancies Act, do come into force on and not before August 1, 2024; Now Know Ye That We, by and with the advice of the Executive Council of Nova Scotia, do by this Our Proclamation order and declare that Sections 10 and 11 of
Chapter 36 of the Acts of 2021,
An Act to Amend
Chapter 401 of the Revised Statutes, 1989, the Residential Tenancies Act, do come into force on and not before August 1, 2024, of which all persons concerned are to take notice and govern themselves accordingly. In Testimony Whereof We have caused these our Letters to be made Patent and the Great Seal of Nova Scotia to be hereunto affixed. Witness, Our Trusty and Well Beloved, Arthur J. LeBlanc, Chancellor of Our Order of Nova Scotia, one of Our Counsel learned in the law in the Province of Nova Scotia, Lieutenant Governor in and of Our Province of Nova Scotia.
Given at Our Government House in the Halifax Regional Municipality, this 16th day of July in the year of Our Lord two thousand and twenty-four and in the Second year of Our Reign. By Command: PROVINCIAL SECRETARY ATTORNEY GENERAL AND MINISTER OF JUSTICE N.S. Reg. 140/2024 Made: July 16, 2024 Filed: July 16, 2024 Residential Tenancies Regulations–amendment Order in Council 2024-281 dated July 16, 2024 Amendment to regulations made by the Governor in Council pursuant to
Section 26 of the Residential Tenancies Act The Governor in Council on the report and recommendation of the Minister of Service Nova Scotia dated June 13, 2024, and pursuant to
Section 26 of
Chapter 401 of the Revised Statutes of Nova Scotia, 1989, the Residential Tenancies Act, is pleased to amend the Residential Tenancies Regulations, N.S. Reg. 190/1989, made by the Governor in Council by Order in Council 89-1118 dated September 26, 1989, in the manner set forth in
Schedule “A” attached to and forming part of the report and recommendation, effective on and after August 1, 2024.
Schedule “A” Amendment to the Residential Tenancies Regulations made by the Governor in Council under
Section 26 of
Chapter 401 of the Revised Statutes of Nova Scotia, 1989, the Residential Tenancies Act 1 The Residential Tenancies Regulations, N.S. Reg. 190/1989, made by the Governor in Council by Order 354
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Part II - Regulations Vol. 48, No. 15 in Council 89-1118 dated September 26, 1989, are amended by adding the following Sections immediately after
Section 4J: Security deposit claim form 4K A security deposit claim form to be filed with the Director under subsection 12A(2) of the Act must be in Form R: Security Deposit Claim Form. Tenant’s application to Director requesting return of security deposit 4L A tenant’s application to the Director to request the return of a security deposit under Sections 12B and 13 of the Act must be in Form S: Application to Director—Ret urn of Security Deposit. 2
Section 24C of the regulations is amended by adding “Section 4L or” immediately before “Section 24D”. 3 The table of prescribed forms in
Section 35 of the regulations is amended by adding the following rows immediately after the row for Form Q: R Security deposit claim form to be filed with Director under subsection 12A(2) of Act S Application to Director requesting return of security deposit under Sections 12B and 13 of Act 4
(1) Form J of the regulations is amended under the heading “Details of Application” by striking out “[ ] Return of security deposit” and the three blank lines immediately below it.
(2) Form J is further amended under the heading “Details of Application” by striking out “[ ] Retention of security deposit” and the three blank lines immediately below it. 5 The regulations are further amended by adding the attached Form R: Security Deposit Claim Form immediately after Form Q. 6 The regulations are further amended by adding the attached Form S: Application to Director— Return of Security Deposit immediately after Form R.
Form R: Security Deposit Claim Form File Number: ____________ Security Deposit Claim Form (under subsection 12A(2) of the Residential Tenancies Act) Important Information A landlord must return the security deposit to a tenant within 10 days of the termination of the lease unless at least one of the following applies: • there is unpaid rent; • there are damages to the rental unit for which the tenant is responsible; or • the tenant consents in writing to the landlord retaining all or part of the security deposit.
If the landlord wishes to keep all or part of the security deposit, the landlord must: • Submit this form to the Director of Residential Tenancies within 10 days of the termination of the lease if any part of the security deposit is being withheld without the written consent of the tenant. Additional 355
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Part II - Regulations Vol. 48, No. 15 information on the Counting Days Policy can be found at www.novascotia.ca/rta. • Send a copy of this form to the tenant within 10 days of the termination of the lease, in one of the following ways: • by registered mail, express post or courier to the tenant’s new address, if known. Keep a copy of the receipt showing proof the notice was properly addressed and sent. • electronically, if the tenant provided an e-mail address in the lease.
Keep a copy of the e-mail showing the date and time it was sent. • if the tenant’s new address is not known and no e-mail address for the tenant is indicated on the lease, by registered mail, express post or courier to the address for the next of kin, if indicated on the lease. If the landlord does not file this form with the Director and send a copy of it to the tenant within 10 days of the date of the termination of the lease, the landlord is not permitted to make an application to the Director to retain the security deposit and must return the security deposit to the tenant.
If unpaid rent or damages, or both, exceed the amount of the security deposit, the landlord may file a Form J: Application to Director to book a hearing. For all other disputes, use Form J: Application to Director. Instructions on using Form J can be found at www.novascotia.ca/rta.
Rental Unit Address of rental unit: Civic address (street number, street name, apt. number): City/town: Province: Postal code: Landlord Information Name (company name, if applicable): Civic address (street number, street name, apt. number): City/town: Province: Postal code: Phone (home): Phone (business/other): Mailing address (if different): E-mail address: G I hereby consent to staff of Service Nova Scotia communicating with me about this form by e-mail. Tenant Information Name (full name): 356
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Part II - Regulations Vol. 48, No. 15 Civic address (street number, street name, apt. number): City/town: Province: Postal code: Phone (home): Phone (business/other): Mailing address (if different): E-mail address: Deductions From Security Deposit Description of deductions Amount Total: Security Deposit Accounting Amount of deposit Date deposit paid Balance $_______________ _______________ (YYYY/MM/DD) $____________ Landlord’s signature: ___________________________ Date: _____________ (YYYY/MM/DD) ________________________________________________________________ Form S: Application to Director— Return of Security Deposit File Number: ____________ Application to Director— Return of Security Deposit (under Sections 12B and 13 of the Residential Tenancies Act) Important Information This form is for a tenant who is applying to have their security deposit returned if more than 10 days have passed since the termination of a lease.
Additional information on the Counting Days Policy can be found at www.novascotia.ca/rta. 357
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Part II - Regulations Vol. 48, No. 15 You may apply to have your security deposit returned if more than 10 days have passed since the termination of the lease and one of the following has occurred: • You did not consent in writing to your landlord retaining all or part of the security deposit and you did not receive your security deposit or a copy of a Form R: Security Deposit Claim Form; or • Your landlord filed a Form R: Security Deposit Claim Form and you wish to dispute your landlord’s claim to the security deposit.
The applicant must serve the landlord with a copy of this application and return to the Access Centre to file an Affidavit of Service in Form L or a Certificate of Service in Form L1 before the application will be reviewed by a Residential Tenancy Officer. For all other disputes, use Form J: Application to Director. Instructions on using Form J can be found at www.novascotia.ca/rta.
Rental Unit Address of rental unit: Civic address (street number, street name, apt. number): City/town: Province: Postal code: Tenant Information Name (full name): Civic address (street number, street name, apt. number): City/town: Province: Postal code: Phone (home): Phone (business/other): Mailing address (if different): E-mail address: G I hereby consent to staff of Service Nova Scotia communicating with me about this Application by e-mail.
Landlord Information Name (company name, if applicable): Civic address (street number, street name, apt. number): City/town: Province: Postal code: Phone (home): Phone (business/other): 358
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Part II - Regulations Vol. 48, No. 15 Mailing address (if different): E-mail address: Details of Application Amount of security deposit Date security deposit paid $_____________________ _______________ (YYYY/MM/DD) This is an application for: G Return of security deposit in the amount of $____________ G Costs of the application fee Reason for application (check which of the following applies): G I did not consent in writing to the landlord retaining all or part of the security deposit and I did not receive my security deposit within 10 days of the date of termination of the lease or a copy of a Form R: Security Deposit Claim Form.
G My landlord filed a Form R: Security Deposit Claim Form and I wish to dispute my landlord’s claim to the security deposit. Information about the lease Is there a written lease? G Yes G No What date did the tenancy start? ________________ (YYYY/MM/DD) What date did the tenancy terminate? ________________ (YYYY/MM/DD) Applicant’s signature: ___________________________ Date: _____________ (YYYY/MM/DD) 359