HomeMy WebLinkAboutForm CN03 - Notice of Intent - FillableNOTE: The personal information on this form is being collected to support the administrative requirements of the local authorities
election process and is authorized under section 147.22 of the Local Authorities Election Act and section 4 of the Protection of Privacy
Act. If you have any questions concerning the collection of this personal information, please contact the Privacy Officer for the County
of Newell at 403-794-2319 or nielsena@newellmail.ca.
NOTICE OF INTENT
Local Authorities Election Act
(Sections 147.22)
LOCAL JURISDICTION: ________________________________, PROVINCE OF ALBERTA
Election Date: October 20, 2025
I, , of
Candidate’s full name
Candidate’s complete address and postal code
intend to be nominated, or have been nominated, to run for election as a candidate in the
Name of Electoral Division
I understand that by completing this form, I am declaring my intent to become a candidate as defined in
the Local Authorities Election Act, which carries with it certain obligations and responsibilities.
Candidate Information
Title (i.e. Mr., Ms, Dr.) Candidate’s Last Name Candidate’s First Name
Gender Telephone Number Email Address
Address of place(s) where candidate records are maintained:
Name(s) and address(es) of financial institutions where campaign contributions will be deposited (if applicable):
Name(s) of signing authorities for each depository listed above (if applicable):
SWORN (AFFIRMED) BEFORE ME
at the ____ of ____________________
in the Province of Alberta,
this ____ day of _______________________, 2025.
(Candidate’s Signature)
(Signature of Returning Officer or Commissioner for Oaths
or Notary Public in and for Alberta)
(Expiry date of Commission)
RETURNING OFFICER’S ACCEPTANCE
Returning Officer signals acceptance by signing this form:
(Signature of Returning Officer)
IT IS AN OFFENCE TO SIGN A FALSE AFFIDAVIT OR A FORM THAT CONTAINS A FALSE STATEMENT