I, , of Alberta, SWEAR/AFFIRM and SAY THAT

Form 49 [Rule 13.19]

COURT FILE NUMBER Clerk’s Stamp COURT COURT OF QUEEN’S BENCH OF ALBERTA

JUDICIAL CENTRE

PLAINTIFF(S)

DEFENDANT(S)

DOCUMENT AFFIDAVIT

ADDRESS FOR SERVICE AND CONTACT INFORMATION OF PARTY FILING THIS DOCUMENT

AFFIDAVIT OF [name]

Sworn (or Affirmed) on [date], 20

I, , of Alberta, SWEAR/AFFIRM AND SAY THAT:

1. 2. 3.

SWORN (OR AFFIRMED) BEFORE ME at [City], ) Alberta, this [Date] day of [Month], 20[Year]. ) ) ) ______) ______(Commissioner for Oaths in and for the Province ) (Signature) of Alberta) ) ) ) ______) ______PRINT NAME AND EXPIRY/LAWYER ) (Print Name) /STUDENT-AT-LAW

This is exhibit __ referred to in the affidavit of ______sworn before me on ______, 20______.

______

A Commissioner of Oaths for the Province of Alberta

______PRINT NAME AND EXPIRY/LAWYER /STUDENT-AT-LAW