Referendum, Senate Election and Local Authorities Election Forms Regulation (Alta. Reg. 254/2020)

Alta. Reg. 254/2020

Alberta — Regulations

© Published by Alberta King’s Printer Alberta King’s Printer Suite 700, Park Plaza 10611 - 98 Avenue Edmonton, AB T5K 2P7 Phone: 780-427-4952 E-mail: kings-printer@gov.ab.ca Shop on-line at kings-printer.alberta.ca Province of Alberta Office Consolidation Alberta Regulation 254/2020 With amendments up to and including Alberta Regulation 150/2025 Current as of July 4, 2025 REFERENDUM ACT ALBERTA SENATE ELECTION ACT LOCAL AUTHORITIES ELECTION ACT REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION

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Note All persons making use of this consolidation are reminded that it has no legislative sanction, that amendments have been embodied for convenience of reference only. The official Statutes and Regulations should be consulted for all purposes of interpreting and applying the law.

(Consolidated up to 150/2025) ALBERTA REGULATION 254/2020 Referendum Act Alberta Senate Election Act Local Authorities Election Act REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION Table of Contents 1

Definitions 2 Referendum forms 3 Senate election forms 4 Referendum and Senate election forms 5 Modified forms 6 Repeal Schedules

Definitions 1 In this Regulation, (a) “general election” means a g eneral election as defined by

section 1(

p) of the Local Authorities Election Act; (b) “local authority election fo rm” means a form prescribed in the Local Authorities Election Forms Regulation (AR 106/2007); (c) “referendum” means a referendum conducted under the Referendum Act; (d) “Senate election” means an election conducted under the Alberta Senate Election Act; (e) “supplementary form” means a form set out in

Schedule 1, 2 or 3. Referendum forms 2 Where a referendum is to be held in conjunction with general elections,

Section 3 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 2 (

a) local authority election forms 3 to 5, 8 to 12, 14, 15, 17 , 20, 21 and 24 to 28 may be used, without making any changes, (

b) supplementary forms 1R, 2R, 7R, 13R, 13R SV, 16R, 22R and 23R set out in

Schedule 1 must be used instead of local authority election forms 1, 2, 7, 13, 13 SV, 16, 22 and 23, and (

c) supplementary forms 18R and 19R set out in

Schedule 1 must be used in the referendum and local authority election forms 18 and 19 must be used for general elections. AR 254/2020 s2;150/2025 Senate election forms 3 Where a Senate election is to be held in conjunction with general elections, (

a) local authority election forms 3 to 5, 8 to 12, 14, 15, 17 , 20, 21 and 24 to 28 may be used, without making any changes, (

b) supplementary forms 1SE, 2SE, 7SE, 13SE, 13SE SV, 16SE, 22SE and 23SE set out in

Schedule 2 must be used instead of local authority election forms 1, 2, 7, 13, 13 SV, 16, 22 and 23, and (

c) supplementary forms 18SE and 19SE set out in

Schedule 2 must be used in the Senate election and local authority election forms 18 and 19 must be used for general elections. AR 254/2020 s3;150/2025 Referendum and Senate election forms 4 Where a referendum and a Senate election are to be held in conjunction with general elections, (

a) local authority election forms 3 to 5, 8 to 12, 14, 15, 17 , 20, 21 and 24 to 28 may be used, without making any changes, (

b) supplementary forms 1RSE, 2RSE, 7RSE, 13RSE, 13RSE SV, 16RSE, 22RSE and 23RSE set out in

Schedule 3 must be used instead of local authority election forms 1, 2, 7, 13, 13 SV, 16, 22 and 23, and (

c) supplementary forms 18RSE and 19RSE set out in

Schedule 3 must be used in the referendum and Senate

Section 5 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 3 election and local authority election forms 18 and 19 must be used for general elections. AR 254/2020 s4;150/2025 Modified forms 5 Where a referendum, a Senate election or both a referendum and a Senate election are to be held in conjunction with general elections, the Minister of Municipal Affairs may issue modified forms if the Minister considers the provisions of this Regulation insufficient. Repeal 6 The Senate Election and Local Authorities Election Forms Regulation (AR 104/2020) is repealed.

Schedule 1 FORM 1R OATH OF RETURNING OFFICER Local Authorities Election Act (Section 16) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: I, (name of person taking oath) , solemnly swear (affirm) THAT I will diligently, faithfully and to the best of my ability execute according to law the office of Returning Officer; THAT I will not communicate to any person any information obtained at an election or in the course of carrying out my duties as to the candidate or candidates for whom a person has voted, or at a vote on a bylaw or question, as to whether a person has voted for or against a bylaw or question; THAT I will not communicate to any person any information obtained at an election or in the course of carrying out my duties as to whether a person has voted for or against a referendum question; THAT, where applicable, I will not communicate to any person any information obtained in the course of carrying out my duties as a returning officer; and THAT I will in all respects maintain and aid in maintaining the absolute secrecy of the vote.

Schedule 1 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 4 SWORN (AFFIRMED) BEFORE ME ) at the of , in the Province ) of Alberta, this day of , ) (Signature of Person Taking Oath) 20 . ) ) (Signature of Commissioner for Oaths) IT IS AN OFFENCE TO SIGN A FALSE AFFIDAVIT The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) .

FORM 2R STATEMENT OF DEPUTY, SUBSTITUTE AND CONSTABLE Local Authorities Election Act (Section 16) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: I, (name of deputy, substitute or constable) , solemnly state that ● I will diligently, faithfully and to the best of my abili ty execute according to law the office of (office appointed to) , ● I will not communicate to any person any information obtained at an election or in the course of carrying out my duties as to the candidate or candidates for whom a person has voted, or at a vote on a bylaw or question as to whether a person has voted for or against a bylaw or question, ● I will not communicate to any person any information obtained at an election or in the course of carrying out my duties as to whether a person has voted for or against a referendum question, ● Where applicable, I will not communicate to any person an y information obtained in the course of carrying out my duties as a deputy, substitute or constable, and ● I will in all respects maintain and aid in maintaining th e absolute secrecy of the vote.

Signature of Deputy, S ubstitute or Constable IT IS AN OFFENCE TO SIGN A FALSE STATEMENT The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact

Schedule 1 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 5 (contact information: business title/organization, phone number and address) . FORM 6R Repealed AR 150/2025 s5 FORM 7R NOTICE OF ELECTION AND REQUIREMENTS FOR VOTER IDENTIFICATION Local Authorities Election Act (Sections 12, 35, 46, 53) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA Notice is hereby given: A That an election will be held for the filling of the following offices: Office(

s) Number of Vacancies Ward or Electoral Division Number (If Applicable) B That a vote of the electors will be held on the following referendum question(

s) under the Referendum Act: (Specific referendum question(

s) to be voted on) Voting will take place on the day of , 20 , between the hours of (start time) and (closing time) . Voting stations will be located at: In order to vote, you must produce for inspection one or more of the acceptable forms of identification required by

section 53 of the Local Authorities Election Act. DATED at the of , in the Province of Alberta, this day of , 20 . (Returning Officer)

Schedule 1 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 6 FORM 13R ELECTOR REGISTER Local Authorities Election Act (Sections 1(n.1), 47, 49, 53, 59, 77.1, 78) Education Act (Sections 4(4), 74) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: VOTING SUBDIVISION OR WARD (If applicable): VOTING STATION: STATEMENT OF ELECTOR ELIGIBILITY I, (name of elector) of (complete address and postal code) , born on (birth date) , am eligible to vote at the above-mentioned election because ● I have not voted bef ore in this election, ● I am 18 years of age or older, ● I am a Canadian citizen, ● My place of resid ence is in the voting subdivision or ward on election day, and ● I have provided the required proof of eligibility as requ ired by

section 53 of the Local Authorities Election Act, or, if applicable, I have provided identification for inspection and my residence has been vouched for.

I am eligible to vote for: Select one (if applicable) □ A Public School Trustee □ A Separate School Trustee Signature of Electo r IT IS AN OFFENCE TO SIGN A FALSE STATEMENT DEPUTY RETURNING OFFICER (Deputy’s initials) VOTER NUMBER: □ Identification shown Select one: □ Elector on permanent electors register for the above-named local jurisdiction □ Elector NOT on the permanent electors register for the above-named local jurisdiction, and the statement of elector eligibility was completed If the elector is not on the permanent electors register, select one: □ Proof of residence shown □ Elector’s residence vouched for, if applicable

Schedule 1 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 7 BALLOTS ISSUED TO ELECTOR □ Chief Elected Official □ Bylaw or Question □ Councillors □ Separate School Trustee □ Public School Trustee □ Referendum Question(

s) ELECTOR WHO IS UNABLE TO VOTE IN THE USUAL MANNER □ Ballot of elector who is unable to vote in the usual manner was marked by another person Reason: The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) .

FORM 13R SV ELECTOR REGISTER FOR SUMMER VILLAGES Local Authorities Election Act (Sections 1(n.1), 12, 47 , 49, 53, 59, 77.1, 78) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: VOTING SUBDIVISION OR WARD (If applicable): VOTING STATION: STATEMENT OF ELECTOR ELIGIBILITY I, (name of elector) of (complete address and postal code) , born on (birth date) , am eligible to vote at the above-mentioned election because ● I have not voted bef ore in this election, ● I am 18 years of age or older, ● I am a Canadian citizen, ● I have provided the required proof of eligibility as requ ired by

section 53 of the Local Authorities Election Act, or, if applicable, I have provided identification for inspection and my residence has been vouched for by an elector, and ● Select one: □ I am named on the certificate of title as the person who owns property within the summer village, or I am the spouse or adult interdependent partner of the person named. □ My place of residence is in the summer village on election day. Signature of Elector IT IS AN OFFENCE TO SIGN A FALSE STATEMENT

Schedule 1 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 8 DEPUTY RETURNING OFFICER (Deputy’s initials) VOTER NUMBER: □ Identification shown Select one: □ Elector on the permanent electors register for the above-named local jurisdiction. □ Elector NOT on the permanent electors register for the above-named local jurisdiction, and the statement of elector eligibility was completed. □ Above-named local jurisdiction does not have a permanent electors register, and the statement of elector eligibility was completed.

If the elector is not on an applicable permanent electors register, select one: □ Proof of residence shown □ Elector’s residence vouched for, if applicable BALLOTS ISSUED TO ELECTOR □ Chief Elected Official □ Bylaw or Question □ Councillors □ Referendum Question(

s) ELECTOR WHO IS UNABLE TO VOTE IN THE USUAL MANNER □ Ballot of elector who is unable to vote in the usual manner was marked by another person Reason: The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) . FORM 16R STATEMENT OF SCRUTINEER OR OFFICIAL AGENT Local Authorities Election Act (Sections 16(2), 68.1, 69, 70) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE (OR VOTE ON A BYLAW OR QUESTION): I, (name of scrutineer or official agent) , of (complete address and postal code) in the Province of (name of province) , am at least 18 years of age and,

Schedule 1 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 9 (

a) FOR THE PURPOSES OF AN ELECTION, will act as scrutineer on behalf of (name of candidate) for the office of (office for which candidate was nominated) OR (

b) FOR THE PURPOSES OF A VOTE ON A BYLAW, will act as scrutineer for those persons who are interested in (Check [√] One) □ promoting the passing of Bylaw No. □ opposing the passing of Bylaw No. OR (

c) FOR THE PURPOSES OF A VOTE ON A QUESTION, will act as scrutineer on behalf of those persons who are interested in (Check [√] One) □ voting in the positive on the question set out □ voting in the negative on the question set out OR (

d) FOR THE PURPOSES OF A VOTE ON A REFERENDUM QUESTION(S), will act as scrutineer on behalf of those persons who are interested in (Check [√] One) □ voting in the positive on the question(

s) set out □ voting in the negative on the question(

s) set out AND I will in all respects maintain and aid in maintaining the absolute secrecy of the vote. (Signature of Scrutineer or Official Agent) IT IS AN OFFENCE TO SIGN A FALSE STATEMENT The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) .

Schedule 1 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 10 FORM 18R NOTE OF OBJECTION TO A BALLOT for (Name of Office , Bylaw or Question) Local Authorities Election Act (Section 87) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: VOTING SUBDIVISION OR WARD (If Applicable): VOTING STATION: Objection Number Name of Official Agent or Scrutineer Making Objection Reason for Objection 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) .

Schedule 1 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 11 FORM 19R BALLOT ACCOUNT AND RESULT OF VOTE for Senate Nominee Local Authorities Election Act (Sections 77.2, 88, 89) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: VOTING SUBDIVISION OR WARD (If Applicable): VOTING STATION: Result of Vote Names of Candidates (or Question, or Description of Bylaw) Number of VALID Ballots Marked for Each Candidate (or For and Against on a Question or Bylaw) (Continue on Reverse if Required) Ballot Account (

a) Number of Ballots Supplied (

b) Number of Special Ballots Sent Out + ======* (

c) Valid Ballots (

d) Valid Special Ballots Receive d + (

e) Rejected Ballots + (

f) Rejected Special Bal lots + (

g) Spoiled Ballots + (

h) Unused Ballots + (

i) Ballots Not Accounted Fo r + (

j) Special Ballots Not Returne d + (

k) Total ======* *Total number of ballots in (

a) and (

b) must equal (k); the total number of ballots in (c), (d), (e), (f), (g), (h), (

i) and (

j) must equal (k).

Schedule 1 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 12 Valid Ballots for: Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Number of Ballots: Valid Ballots Objected To ____________ Rejected Ballots On Which No Vote Was Cast by an Electo r ____________ DATED this day of , 20 . (Signatures of at least 2 Deputies) (Signatures of Candidates/ Official Agents/Scrutineers who desire to sign) (HAND THIS FORM TO THE RETURNING OFFICER) The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) . FORM 22R REQUEST FOR SPECIAL BALLOT PACKAGE Local Authorities Election Act (Section 77.1) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: VOTING SUBDIVISION OR WARD (If applicable): VOTING STATION: I, (printed first name and surname) of (complete address and postal code) , am unable to vote at an advance voting station or at the voting station on election day. Select one:

Schedule 1 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 13 □ I am properly on the permanent e lectors register for the above-named local jurisdiction. □ I am not on the permanent elect ors register for the above-named local jurisdiction, and I am applying to be added to the permanent electors register. I have included  a copy of my identification, and  a completed statement of elector eligibility on Form 13R (Elector Register) or, in the case of summer villages, on Form 13R SV (Elector Register for Summer Villages).

I request a special ballot package including one of each of the following ballots: Select: □ Chief Elected Official □ Councillors □ Bylaw or Question □ Referendum Question Select one (if applicable): □ A Public School Trustee □ A Separate School Trustee Select one: □ I would like my special ballot package sent by regular mail to the following address: (complete address to which the application will be mailed, including the postal code) . □ I will arrange for my special ba llot package to be picked up during regular office hours.

I would like my package held for pick up. (date of request) Contact telephone number: Contact email address: (Instruction: If the local jurisdiction has authorized applications by telephone under

section 77.1(2) of the Local Authorities Election Act and an application is made by telephone, an election official will fill in this form with the information provided by the elector. If a person must provide a copy of their identification because they are not on the permanent electors register, an application cannot be made by telephone.) The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) .

Schedule 1 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 14 FORM 23R SPECIAL BALLOT PACKAGE Local Authorities Election Act (Sections 77.1, 77.2) Referendum Act (Section 7) SPECIAL BALLOT SPECIAL BALLOT FORM FOR CHIEF ELECTED OFFICIAL (CEO) ELECTION OF CEO FOR THE (Local Jurisdiction) Print the name of the candidate on the line below. I vote for: This ballot shall not be marked for more than one candidate. SPECIAL BALLOT FORM FOR OTHER ELECTED OFFICES ELECTION OF (Office) FOR THE (Local Jurisdiction) Print the name(

s) of the candidate(

s) on the lines below. I vote for: The maximum number of candidates that can be voted for is (number) . USING SEPARATE BALLOTS FOR EACH OFFICE A separate ballot must be used for: ● the office of chief elected official; ● the offices of councillors; ● the offices of school trustees; ● referendum question(s). BALLOT FOR A VOTE ON A BYLAW OR QUESTION The wording on a ballot for a vote on a bylaw or question must be determined by a resolution of the elected authority. The form of the ballot may be determined by a resolution of the elected authority; however, if no resolution is passed, the returning officer must determine the form in accordance with

section 44 of the Local Authorities Election Act. ARRANGING THE NAMES ON THE BALLOTS If an elected authority provides for another method of voting under

section 77.2(2) of the Local Authorities Election Act, the names of the candidates on each ballot must be arranged alphabetically in order of the surnames

Schedule 2 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 15 and, if 2 or more candidates have the same surname, the names of those candidates must be arranged alphabetically in order of their given names. If an elected authority passes a bylaw 2 months before an election that provides that ballots be printed in as many lots as there are candidates for the office,

section 43(3) of the Local Authorities Election Act applies. INDICATING THE NUMBER OF CANDIDATES THAT CAN BE VOTED FOR Every ballot used in an election for a member of an elected authority must contain a brief explanatory note stating the maximum number of candidates that can be voted for in order for the ballot not to be rejected, and every ballot used in an election for chief elected official must contain a brief explanatory note stating that the ballot shall not be marked for more than one candidate. BALLOTS FOR PUBLIC OR SEPARATE MEMBERS Every ballot should indicate if the elector is voting for a public or separate candidate. AR 254/2020 Sched 1;142/2025;150/2025

Schedule 2 FORM 1SE OATH OF RETURNING OFFICER Local Authorities Election Act (Section 16) Alberta Senate Election Act (Section 37) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: .

I, (name of person taking oath) , solemnly swear (affirm) THAT I will diligently, faithfully and to the best of my ability execute according to law the office of Returning Officer; THAT I will not communicate to any person any information obtained at an election or in the course of carrying out my duties as to the candidate or candidates for whom a person has voted, or at a vote on a bylaw or question, as to whether a person has voted for or against a bylaw or question; THAT I will not communicate to any person any information obtained at an election or in the course of carrying out my duties as to the Senate nominee candidate or candidates for whom a person has voted;

Schedule 2 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 16 THAT, where applicable, I will not communicate to any person any information obtained in the course of carrying out my duties as a returning officer; and THAT I will in all respects maintain and aid in maintaining the absolute secrecy of the vote. SWORN (AFFIRMED) BEFORE ME at the of , in the Province of Alberta, this day of , (Signature of Person Taking Oath) 20 . (Signature of Commissioner for Oaths) IT IS AN OFFENCE TO SIGN A FALSE AFFIDAVIT The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) .

FORM 2SE STATEMENT OF DEPUTY, SUBSTITUTE AND CONSTABLE Local Authorities Election Act (Section 16) Alberta Senate Election Act (Section 37) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: I, (name of deputy, substitute or constable) , solemnly state that ● I will diligently, faithfully and to the best of my abili ty execute according to law the office of (office appointed to) , ● I will not communicate to any person any information obtained at an election or in the course of carrying out my duties as to the candidate or candidates for whom a person has voted, or at a vote on a bylaw or question as to whether a person has voted for or against a bylaw or question, ● I will not communicate to any person any information obtained at an election or in the course of carrying out my duties as to the

Schedule 2 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 17 Senate nominee candidate or candidates for whom a person has voted, ● Where applicable, I will not communicate to any person an y information obtained in the course of carrying out my duties as a deputy, substitute or constable, and ● I will in all respects maintain and aid in maintaining th e absolute secrecy of the vote. Signature of Deputy, S ubstitute or Constable IT IS AN OFFENCE TO SIGN A FALSE STATEMENT The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) . FORM 6SE Repealed AR 150/2025 s6 FORM 7SE NOTICE OF ELECTION AND REQUIREMENTS FOR VOTER IDENTIFICATION Local Authorities Election Act (Sections 12, 35, 46, 53) Alberta Senate Election Act (Sections 5, 37) LOCAL JURISDICTION: , PROVINCE OF ALBERTA Notice is hereby given: _________________________________________________ A That an election will be held for the filling of the following offices: Office(

s) Number of Vacancies Ward or Electoral Division Number (If Applicable)

Schedule 2 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 18 B That an election will be held for the election of a Senate nominee for the purposes of the Alberta Senate Election Act. Voting will take place on the day of , 20 , between the hours of (start time) and (closing time) . Voting stations will be located at: _____________________ _________________________________ _____________________________ _________________________ In order to vote, you must produce for inspection one or more of the acceptable forms of identification required by

section 53 of the Local Authorities Election Act. DATED at the of , in the Province of Alberta, this day of , 20 . (Returning Officer) FORM 13SE ELECTOR REGISTER Local Authorities Election Act (Sections 1(n.1), 47, 49, 53, 59, 77.1, 78) Education Act (Sections 4(4), 74) Alberta Senate Election Act (Sections 5, 37) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: VOTING SUBDIVISION OR WARD (If applicable): VOTING STATION:

Schedule 2 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 19 STATEMENT OF ELECTOR ELIGIBILITY I, (name of elector) of (complete address and postal code) , born on (birth date) , am eligible to vote at the above-mentioned election because ● I have not voted bef ore in this election, ● I am 18 years of age or older, ● I am a Canadian citizen, ● My place of resid ence is in the voting subdivision or ward on election day, and ● I have provided the required proof of eligibility as requi red by

section 53 of the Local Authorities Election Act, or, if applicable, I have provided identification for inspection and my residence has been vouched for.

I am eligible to vote for: Select one (if applicable) □ A Public School Trustee □ A Separate School Trustee Signature of Electo r IT IS AN OFFENCE TO SIGN A FALSE STATEMENT DEPUTY RETURNING OFFICER (Deputy’s initials) VOTER NUMBER: □ Identification shown Select one: □ Elector on permanent electors register for the above-named local jurisdiction □ Elector NOT on the permanent electors register for the above-named local jurisdiction, and the statement of elector eligibility was completed If the elector is not on the permanent electors register, select one: □ Proof of residence shown □ Elector’s residence vouched for, if applicable BALLOTS ISSUED TO ELECTOR □ Chief Elected Official □ Bylaw or Question □ Councillors □ Separate School Trustee □ Public School Trustee □ Senate Nominee ELECTOR WHO IS UNABLE TO VOTE IN THE USUAL MANNER □ Ballot of elector who is unable to vote in the usual manner was marked by another person Reason: The personal information collected through this form is for administering the election.

This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact

Schedule 2 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 20 (contact information: business title/organization, phone number and address) .

FORM 13SE SV ELECTOR REGISTER FOR SUMMER VILLAGES Local Authorities Election Act (Sections 1(n.1), 12, 47 , 49, 53, 59, 77.1, 78) Alberta Senate Election Act (Sections 5, 37) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: VOTING SUBDIVISION OR WARD (If applicable): VOTING STATION: STATEMENT OF ELECTOR ELIGIBILITY I, (name of elector) of (complete address and postal code) , born on (birth date) , am eligible to vote at the above-mentioned election because ● I have not voted bef ore in this election, ● I am 18 years of age or older, ● I am a Canadian citizen, ● I have provided the required proof of eligibility as requ ired by

section 53 of the Local Authorities Election Act, or, if applicable, I have provided identification for inspection and my residence has been vouched for by an elector, and ● Select one: □ I am named on the certificate of title as the person who owns property within the summer village, or I am the spouse or adult interdependent partner of the person named. □ My place of residence is in the summer village on election day.

Signature of Elector IT IS AN OFFENCE TO SIGN A FALSE STATEMENT DEPUTY RETURNING OFFICER (Deputy’s initials) VOTER NUMBER: □ Identification shown Select one: □ Elector on the permanent electors register for the above-named local jurisdiction. □ Elector NOT on the permanent electors register for the above-named local jurisdiction, and the statement of elector eligibility was completed. □ Above-named local jurisdiction does not have a permanent electors register, and the statement of elector eligibility was completed.

Schedule 2 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 21 If the elector is not on an applicable permanent electors register, select one: □ Proof of residence shown □ Elector’s residence vouched for, if applicable BALLOTS ISSUED TO ELECTOR □ Chief Elected Official □ Bylaw or Question □ Councillors □ Senate Nominee ELECTOR WHO IS UNABLE TO VOTE IN THE USUAL MANNER □ Ballot of elector who is unable to vote in the usual manner was marked by another person Reason: The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) . FORM 16SE STATEMENT OF SCRUTINEER OR OFFICIAL AGENT Local Authorities Election Act (Sections 16(2), 68.1, 69, 70) Alberta Senate Election Act (Section 37) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE (OR VOTE ON A BYLAW OR QUESTION): I, (name of scrutineer or official agent) , of (complete address and postal code) in the Province of (name of province) , am at least 18 years of age and, (

a) FOR THE PURPOSES OF AN ELECTION, will act as scrutineer on behalf of (name of candidate) for the office of (office for which candidate was nominated) OR (

b) FOR THE PURPOSES OF A VOTE ON A BYLAW, will act as scrutineer for those persons who are interested in

Schedule 2 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 22 (Check [√] One) □ promoting the passing of Bylaw No. □ opposing the passing of Bylaw No. OR (

c) FOR THE PURPOSES OF A VOTE ON A QUESTION, will act as scrutineer on behalf of those persons who are interested in (Check [√] One) □ voting in the positive on the question set out □ voting in the negative on the question set out OR (

d) FOR THE PURPOSES OF A SENATE NOMINEE ELECTION, will act as scrutineer on behalf of (name of candidate) for the office of Senate nominee AND I will in all respects maintain and aid in maintaining the absolute secrecy of the vote. (Signature of Scrutineer or Official Agent) IT IS AN OFFENCE TO SIGN A FALSE STATEMENT The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) . FORM 18SE NOTE OF OBJE CTION TO A BALLOT for Senate Nominee Local Authorities Election Act (Section 87) Alberta Senate Election Act (Section 37) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: VOTING SUBDIVISION OR WARD (If Applicable): VOTING STATION:

Schedule 2 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 23 Objection Number Name of Official Agent, Scrutineer or Candidate Making Objection Reason for Objection 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) . FORM 19SE BALLOT ACCOUNT AND RESULT OF VOTE for Senate Nominee Local Authorities Election Act (Sections 77.2, 88, 89) Alberta Senate Election Act (Section 37) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: VOTING SUBDIVISION OR WARD (If Applicable): VOTING STATION: Result of Vote Names of Candidates (or Question, or Description of Bylaw) Number of VALID Ballots Marked for Each Candidate (or For and Against on a

Schedule 2 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 24 Question or Bylaw) (Continue on Reverse if Required) Ballot Account (

a) Number of Ballots Supplied (

b) Number of Special Ballots Sent Out + ======* (

c) Valid Ballots (

d) Valid Special Ballots Receive d + (

e) Rejected Ballots + (

f) Rejected Special Bal lots + (

g) Spoiled Ballots + (

h) Unused Ballots + (

i) Ballots Not Accounted Fo r + (

j) Special Ballots Not Returne d + (

k) Total ======* *Total number of ballots in (

a) and (

b) must equal (k); the total number of ballots in (c), (d), (e), (f), (g), (h), (

i) and (

j) must equal (k). Valid Ballots for: Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Number of Ballots: Valid Ballots Objected To ____________ Rejected Ballots On Which No Vote Was Cast by an Electo r ____________ DATED this day of , 20 . (Signatures of at least 2 Deputies) (Signatures of Candidates/ Official Agents/Scrutineers who desire to sign) (HAND THIS FORM TO THE RETURNING OFFICER)

Schedule 2 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 25 The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) . FORM 22SE REQUEST FOR SPECIAL BALLOT PACKAGE Local Authorities Election Act (Section 77.1) Alberta Senate Election Act (Section 37) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: VOTING SUBDIVISION OR WARD (If applicable): VOTING STATION: I, (printed first name and surname) of (complete address and postal code) , am unable to vote at an advance voting station or at the voting station on election day.

Select one: □ I am properly on the permanent e lectors register for the above-named local jurisdiction. □ I am not on the permanent elect ors register for the above-named local jurisdiction, and I am applying to be added to the permanent electors register. I have included  a copy of my identification, and  a completed statement of elector eligibility on Form 13SE (Elector Register) or, in the case of summer villages, on Form 13SE SV (Elector Register for Summer Villages).

I request a special ballot package including one of each of the following ballots: Select: □ Chief Elected Official □ Councillors □ Bylaw or Question □ Senate Nominee Select one (if applicable): □ A Public School Trustee □ A Separate School Trustee

Schedule 2 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 26 Select one: □ I would like my special ballot package sent by regular mail to the following address: (complete address to which the application will be mailed, including the postal code) . □ I will arrange for my special ba llot package to be picked up during regular office hours. I would like my package held for pick up. (date of request) Contact telephone number: Contact email address: (Instruction: If the local jurisdiction has authorized applications by telephone under

section 77.1(2) of the Local Authorities Election Act and an application is made by telephone, an election official will fill in this form with the information provided by the elector. If a person must provide a copy of their identification because they are not on the permanent electors register, an application cannot be made by telephone.) The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) . FORM 23SE SPECIAL BALLOT PACKAGE Local Authorities Election Act (Sections 77.1, 77.2) Alberta Senate Election Act (Section 37) SPECIAL BALLOT SPECIAL BALLOT FORM FOR CHIEF ELECTED OFFICIAL (CEO) ELECTION OF CEO FOR THE (Local Jurisdiction) Print the name of the candidate on the line below. I vote for: This ballot shall not be marked for more than one candidate.

Schedule 2 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 27 SPECIAL BALLOT FORM FOR OTHER ELECTED OFFICES ELECTION OF (Office) FOR THE (Local Jurisdiction) Print the name(

s) of the candidate(

s) on the lines below. I vote for: The maximum number of candidates that can be voted for is (number) . USING SEPARATE BALLOTS FOR EACH OFFICE A separate ballot must be used for: ● the office of chief elected official; ● the offices of councillors; ● the offices of school trustees; ● Senate nominee. BALLOT FOR A VOTE ON A BYLAW OR QUESTION The wording on a ballot for a vote on a bylaw or question must be determined by a resolution of the elected authority. The form of the ballot may be determined by a resolution of the elected authority; however, if no resolution is passed, the returning officer must determine the form in accordance with

section 44 of the Local Authorities Election Act. ARRANGING THE NAMES ON THE BALLOTS If an elected authority provides for another method of voting under

section 77.2(2) of the Local Authorities Election Act, the names of the candidates on each ballot must be arranged alphabetically in order of the surnames and, if 2 or more candidates have the same surname, the names of those candidates must be arranged alphabetically in order of their given names. If an elected authority passes a bylaw 2 months before an election that provides that ballots be printed in as many lots as there are candidates for the office,

section 43(3) of the Local Authorities Election Act applies. INDICATING THE NUMBER OF CANDIDATES THAT CAN BE VOTED FOR Every ballot used in an election for a member of an elected authority must contain a brief explanatory note stating the maximum number of candidates that can be voted for in order for the ballot not to be rejected, and every ballot used in an election for chief elected official must contain a brief explanatory note stating that the ballot shall not be marked for more than one candidate. BALLOTS FOR PUBLIC OR SEPARATE MEMBERS Every ballot should indicate if the elector is voting for a public or separate candidate. AR 254/2020 Sched 2;142/2025;150/2025

Schedule 3 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 28

Schedule 3 FORM 1RSE OATH OF RETURNING OFFICER Local Authorities Election Act (Section 16) Alberta Senate Election Act (Section 37) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: I, (name of person taking oath) , solemnly swear (affirm) THAT I will diligently, faithfully and to the best of my ability execute according to law the office of Returning Officer; THAT I will not communicate to any person any information obtained at an election or in the course of carrying out my duties as to the candidate or candidates for whom a person has voted, or at a vote on a bylaw or question, as to whether a person has voted for or against a bylaw or question; THAT I will not communicate to any person any information obtained at an election or in the course of carrying out my duties as to the Senate nominee candidate or candidates for whom a person has voted, and as to whether a person has voted for or against a referendum question; THAT, where applicable, I will not communicate to any person any information obtained in the course of carrying out my duties as a returning officer; and THAT I will in all respects maintain and aid in maintaining the absolute secrecy of the vote.

SWORN (AFFIRMED) BEFORE ME ) at the of , in the Province ) of Alberta, this day of , ) (Signature of Person Taking Oath) 20 . ) ) (Signature of Commissioner for Oaths) IT IS AN OFFENCE TO SIGN A FALSE AFFIDAVIT The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) .

Schedule 3 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 29 FORM 2RSE STATEMENT OF DEPUTY, SUBSTITUTE AND CONSTABLE Local Authorities Election Act (Section 16) Alberta Senate Election Act (Section 37) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: I, (name of deputy, substitute or constable) , solemnly state that ● I will diligently, faithfully and to the best of my abili ty execute according to law the office of (office appointed to) , ● I will not communicate to any person any information obtained at an election or in the course of carrying out my duties as to the candidate or candidates for whom a person has voted, or at a vote on a bylaw or question as to whether a person has voted for or against a bylaw or question, ● I will not communicate to any person any information obtained at an election or in the course of carrying out my duties as to the Senate nominee candidate or candidates for whom a person has voted, and as to whether a person has voted for or against a referendum question, ● Where applicable, I will not communicate to any person an y information obtained in the course of carrying out my duties as a deputy, substitute or constable, and ● I will in all respects maintain and aid in maintaining th e absolute secrecy of the vote.

Signature of Deputy, S ubstitute or Constable IT IS AN OFFENCE TO SIGN A FALSE STATEMENT The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) . FORM 6RSE Repealed AR 150/2025 s7 FORM 7RSE NOTICE OF ELECTION AND REQUIREMENTS FOR VOTER IDENTIFICATION Local Authorities Election Act (Sections 12, 35, 46, 53) Alberta Senate Election Act

Schedule 3 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 30 (Sections 5, 37) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA Notice is hereby given: A That an election will be held for the filling of the following offices: Office(

s) Number of Vacancies Ward or Electoral Division Number (If Applicable) B That an election will be held for the election of a Senate nominee for the purposes of the Alberta Senate Election Act; C That a vote of the electors will be held on the following referendum question(

s) under the Referendum Act: (Specific referendum question(

s) to be voted on) Voting will take place on the day of , 20 , between the hours of (start time) and (closing time) . Voting stations will be located at: In order to vote, you must produce for inspection one or more of the acceptable forms of identification required by

section 53 of the Local Authorities Election Act. DATED at the of , in the Province of Alberta, this day of , 20 . (Returning Officer) FORM 13RSE ELECTOR REGISTER Local Authorities Election Act (Sections 1(n.1), 47, 49, 53, 59, 77.1, 78) Education Act (Sections 4(4), 74) Alberta Senate Election Act (Sections 5, 37) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE:

Schedule 3 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 31 VOTING SUBDIVISION OR WARD (If applicable): VOTING STATION: STATEMENT OF ELECTOR ELIGIBILITY I, (name of elector) of (complete address and postal code) , born on (birth date) , am eligible to vote at the above-mentioned election because ● I have not voted bef ore in this election, ● I am 18 years of age or older, ● I am a Canadian citizen, ● My place of resid ence is in the voting subdivision or ward on election day, and ● I have provided the required proof of eligibility as requ ired by

section 53 of the Local Authorities Election Act, or, if applicable, I have provided identification for inspection and my residence has been vouched for.

I am eligible to vote for: Select one (if applicable) □ A Public School Trustee □ A Separate School Trustee Signature of Electo r IT IS AN OFFENCE TO SIGN A FALSE STATEMENT DEPUTY RETURNING OFFICER (Deputy’s initials) VOTER NUMBER: □ Identification shown Select one: □ Elector on permanent electors register for the above-named local jurisdiction □ Elector NOT on the permanent electors register for the above-named local jurisdiction, and the statement of elector eligibility was completed If the elector is not on the permanent electors register, select one: □ Proof of residence shown □ Elector’s residence vouched for, if applicable BALLOTS ISSUED TO ELECTOR □ Chief Elected Official □ Bylaw or Question □ Councillors □ Separate School Trustee □ Public School Trustee □ Senate Nominee □ Referendum Question(

s) ELECTOR WHO IS UNABLE TO □ Ballot of elector who is unable to vote in the usual manner was marked by another person

Schedule 3 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 32 VOTE IN THE USUAL MANNER Reason: The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) .

FORM 13RSE SV ELECTOR REGISTER FOR SUMMER VILLAGES Local Authorities Election Act (Sections 1(n.1), 12, 47 , 49, 53, 59, 77.1, 78) Alberta Senate Election Act (Sections 5, 37) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: VOTING SUBDIVISION OR WARD (If applicable): VOTING STATION: STATEMENT OF ELECTOR ELIGIBILITY I, (name of elector) of (complete address and postal code) , born on (birth date) , am eligible to vote at the above-mentioned election because ● I have not voted bef ore in this election, ● I am 18 years of age or older, ● I am a Canadian citizen, ● I have provided the required proof of eligibility as requ ired by

section 53 of the Local Authorities Election Act, or, if applicable, I have provided identification for inspection and my residence has been vouched for by an elector, and ● Select one: □ I am named on the certificate of title as the person who owns property within the summer village, or I am the spouse or adult interdependent partner of the person named. □ My place of residence is in the summer village on election day. Signature of Elector IT IS AN OFFENCE TO SIGN A FALSE STATEMENT DEPUTY RETURNING OFFICER (Deputy’s initials) VOTER NUMBER: □ Identification shown

Schedule 3 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 33 Select one: □ Elector on the permanent electors register for the above-named local jurisdiction. □ Elector NOT on the permanent electors register for the above-named local jurisdiction, and the statement of elector eligibility was completed. □ Above-named local jurisdiction does not have a permanent electors register, and the statement of elector eligibility was completed.

If the elector is not on an applicable permanent electors register, select one: □ Proof of residence shown □ Elector’s residence vouched for, if applicable BALLOTS ISSUED TO ELECTOR □ Chief Elected Official □ Bylaw or Question □ Councillors □ Senate Nominee □ Referendum Question(

s) ELECTOR WHO IS UNABLE TO VOTE IN THE USUAL MANNER □ Ballot of elector who is unable to vote in the usual manner was marked by another person Reason: The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) . FORM 16RSE STATEMENT OF SCRUTINEER OR OFFICIAL AGENT Local Authorities Election Act (Sections 16(2), 68.1, 69, 70) Alberta Senate Election Act (Section 37) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE (OR VOTE ON A BYLAW OR QUESTION): I, (name of scrutineer or official agent) , of (complete address and postal code) in the Province of (name of province) , am at least 18 years of age and,

Schedule 3 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 34 (

a) FOR THE PURPOSES OF AN ELECTION, will act as scrutineer on behalf of (name of candidate) for the office of (office for which candidate was nominated) OR (

b) FOR THE PURPOSES OF A VOTE ON A BYLAW, will act as scrutineer for those persons who are interested in (Check [√] One) □ promoting the passing of Bylaw No. □ opposing the passing of Bylaw No. OR (

c) FOR THE PURPOSES OF A VOTE ON A QUESTION, will act as scrutineer on behalf of those persons who are interested in (Check [√] One) □ voting in the positive on the question set out □ voting in the negative on the question set out OR (

d) FOR THE PURPOSES OF A SENATE NOMINEE ELECTION, will act as scrutineer on behalf of (name of candidate) for the office Senate nominee OR (

e) FOR THE PURPOSES OF A VOTE ON A REFERENDUM QUESTION(S), will act as scrutineer on behalf of those persons who are interested in (Check [√] One) □ voting in the positive on the question(

s) set out □ voting in the negative on the question(

s) set out AND I will in all respects maintain and aid in maintaining the absolute secrecy of the vote. (Signature of Scrutineer or Official Agent) IT IS AN OFFENCE TO SIGN A FALSE STATEMENT The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) .

Schedule 3 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 35 FORM 18RSE NOTE OF OBJE CTION TO A BALLOT for (Name of Office , Bylaw or Question) Local Authorities Election Act (Section 87) Alberta Senate Election Act (Section 37) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: VOTING SUBDIVISION OR WARD (If Applicable): VOTING STATION: Objection Number Name of Official Agent, Scrutineer or Candidate Making Objection Reason for Objection 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) .

Schedule 3 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 36 FORM 19RSE BALLOT ACCOUNT AND RESULT OF VOTE for Senate Nominee Local Authorities Election Act (Sections 77.2, 88, 89) Alberta Senate Election Act (Section 37) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: VOTING SUBDIVISION OR WARD (If Applicable): VOTING STATION: Result of Vote Names of Candidates (or Question, or Description of Bylaw) Number of VALID Ballots Marked for Each Candidate (or For and Against on a Question or Bylaw) (Continue on Reverse if Required) Ballot Account (

a) Number of Ballots Supplied (

b) Number of Special Ballots Sent Out + ======* (

c) Valid Ballots (

d) Valid Special Ballots Receive d + (

e) Rejected Ballots + (

f) Rejected Special Bal lots + (

g) Spoiled Ballots + (

h) Unused Ballots + (

i) Ballots Not Accounted Fo r + (

j) Special Ballots Not Returne d + (

k) Total ======* *Total number of ballots in (

a) and (

b) must equal (k); the total number of ballots in (c), (d), (e), (f), (g), (h), (

i) and (

j) must equal (k).

Schedule 3 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 37 Valid Ballots for: Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Candidate Number of Ballots: Valid Ballots Objected To ____________ Rejected Ballots On Which No Vote Was Cast by an Electo r ____________ DATED this day of , 20 . (Signatures of at least 2 Deputies) (Signatures of Candidates/ Official Agents/Scrutineers who desire to sign) (HAND THIS FORM TO THE RETURNING OFFICER) The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact (contact information: business title/organization, phone number and address) . FORM 22RSE REQUEST FOR SPECIAL BALLOT PACKAGE Local Authorities Election Act (Section 77.1) Alberta Senate Election Act (Section 37) Referendum Act (Section 7) LOCAL JURISDICTION: , PROVINCE OF ALBERTA ELECTION DATE: VOTING SUBDIVISION OR WARD (If applicable): VOTING STATION: I, (printed first name and surname) of (complete address and postal code) , am unable to vote at an advance voting station or at the voting station on election day.

Schedule 3 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 38 Select one: □ I am properly on the permanent e lectors register for the above-named local jurisdiction. □ I am not on the permanent elect ors register for the above-named local jurisdiction, and I am applying to be added to the permanent electors register. I have included  a copy of my identification, and  a completed statement of elector eligibility on Form 13RSE (Elector Register) or, in the case of summer villages, on Form 13RSE SV (Elector Register for Summer Villages).

I request a special ballot package including one of each of the following ballots: Select: □ Chief Elected Official □ Councillors □ Bylaw or Question □ Senate Nominee □ Referendum Question Select one (if applicable): □ A Public School Trustee □ A Separate School Trustee Select one: □ I would like my special ballot package sent by regular mail to the following address: (complete address to which the application will be mailed, including the postal code) . □ I will arrange for my special ba llot package to be picked up during regular office hours.

I would like my package held for pick up. (date of request) Contact telephone number: Contact email address: (Instruction: If the local jurisdiction has authorized applications by telephone under

section 77.1(2) of the Local Authorities Election Act and an application is made by telephone, an election official will fill in this form with the information provided by the elector. If a person must provide a copy of their identification because they are not on the permanent electors register, an application cannot be made by telephone.) The personal information collected through this form is for administering the election. This collection is authorized by

section 4(

c) of the Protection of Privacy Act. For questions about the collection of personal information, contact

Schedule 3 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 39 (contact information: business title/organization, phone number and address) . FORM 23RSE SPECIAL BALLOT PACKAGE Local Authorities Election Act (Sections 77.1, 77.2) Alberta Senate Election Act (Section 37) Referendum Act (Section 7) SPECIAL BALLOT SPECIAL BALLOT FORM FOR CHIEF ELECTED OFFICIAL (CEO) ELECTION OF CEO FOR THE (Local Jurisdiction) Print the name of the candidate on the line below. I vote for: This ballot shall not be marked for more than one candidate. SPECIAL BALLOT FORM FOR OTHER ELECTED OFFICES ELECTION OF (Office) FOR THE (Local Jurisdiction) Print the name(

s) of the candidate(

s) on the lines below. I vote for: The maximum number of candidates that can be voted for is (number) . USING SEPARATE BALLOTS FOR EACH OFFICE A separate ballot must be used for: ● the office of chief elected official; ● the offices of councillors; ● the offices of school trustees; ● Senate nominee; ● referendum questions(s). BALLOT FOR A VOTE ON A BYLAW OR QUESTION The wording on a ballot for a vote on a bylaw or question must be determined by a resolution of the elected authority. The form of the ballot may be determined by a resolution of the elected authority; however, if no resolution is passed, the returning officer must determine the form in accordance with

section 44 of the Local Authorities Election Act.

Schedule 3 AR 254/2020 REFERENDUM, SENATE ELECTION AND LOCAL AUTHORITIES ELECTION FORMS REGULATION 40 ARRANGING THE NAMES ON THE BALLOTS If an elected authority provides for another method of voting under

section 77.2(2) of the Local Authorities Election Act, the names of the candidates on each ballot must be arranged alphabetically in order of the surnames and, if 2 or more candidates have the same surname, the names of those candidates must be arranged alphabetically in order of their given names. If an elected authority passes a bylaw 2 months before an election that provides that ballots be printed in as many lots as there are candidates for the office,

section 43(3) of the Local Authorities Election Act applies. INDICATING THE NUMBER OF CANDIDATES THAT CAN BE VOTED FOR Every ballot used in an election for a member of an elected authority must contain a brief explanatory note stating the maximum number of candidates that can be voted for in order for the ballot not to be rejected, and every ballot used in an election for chief elected official must contain a brief explanatory note stating that the ballot shall not be marked for more than one candidate. BALLOTS FOR PUBLIC OR SEPARATE MEMBERS Every ballot should indicate if the elector is voting for a public or separate candidate. AR 254/2020 Sched 3;142/2025;150/2025

Printed on Recycled Paper *9780779855650*

Document details

Collection	Alberta — Regulations
Citation	Alta. Reg. 254/2020
Type	regulation
Volume / chapter	2020 254
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	efeec4277c8186d04e50d7241ca3a826f15d34ec

Source file is stored in the law ingest library (pdf).