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Foreign Ownership of Land Regulations (SOR/79-416)

Regulations are current to 2020-09-09

FORM 5Annual Corporate Report of Corporations Owning Controlled Land

ALBERTAEnergy and Natural Resources

Corporation Name:
Corporation address:Address changed to:

Street:

City/Prov.:

P/Code:

Corporation access no.Date registered in Alberta:
  • 1  Is the Corporation a foreign controlled Corporation (as defined in the RegulationFootnote for *)? Yes blank line No blank line .

  • 2  Does the Corporation own controlled land (as defined in the RegulationFootnote for *)? Yes blank line No blank line .

  • 3  Total number of shares issued by the Corporation: Voting blank line Non-Voting blank line

Shareholders / Members

If more than 6 shareholders, use attachment (the attachment will be part of this declaration).

Name:blank line (Surname, First, Int)
Address:blank line
City / Prov.:blank line
P / Code:blank lineblank line
No. of Shares:Voting blank line
Non-Voting blank line
Are these shares or any of them held subject to a trust?
Yes blank line No blank line
Shareholder an ineligible person (as defined in the RegulationFootnote for *)?
Yes blank line No blank line
If a Corporation, Corporation access no. blank line
Name:blank line (Surname, First, Int)
Address:blank line
City / Prov.:blank line
P / Code:blank lineblank line
No. of Shares:Voting blank line
Non-Voting blank line
Are these shares or any of them held subject to a trust?
Yes blank line No blank line
Shareholder an ineligible person (as defined in the RegulationFootnote for *)?
Yes blank line No blank line
If a Corporation, Corporation access no. blank line
Name:blank line (Surname, First, Int)
Address:blank line
City / Prov.:blank line
P / Code:blank lineblank line
No. of Shares:Voting blank line
Non-Voting blank line
Are these shares or any of them held subject to a trust?
Yes blank line No blank line
Shareholder an ineligible person (as defined in the RegulationFootnote for *)?
Yes blank line No blank line
If a Corporation, Corporation access no. blank line
Name:blank line (Surname, First, Int)
Address:blank line
City / Prov.:blank line
P / Code:blank lineblank line
No. of Shares:Voting blank line
Non-Voting blank line
Are these shares or any of them held subject to a trust?
Yes blank line No blank line
Shareholder an ineligible person (as defined in the RegulationFootnote for *)?
Yes blank line No blank line
If a Corporation, Corporation access no. blank line
Name:blank line (Surname, First, Int)
Address:blank line
City / Prov.:blank line
P / Code:blank lineblank line
No. of Shares:Voting blank line
Non-Voting blank line
Are these shares or any of them held subject to a trust?
Yes blank line No blank line
Shareholder an ineligible person (as defined in the RegulationFootnote for *)?
Yes blank line No blank line
If a Corporation, Corporation access no. blank line
Name:blank line (Surname, First, Int)
Address:blank line
City / Prov.:blank line
P / Code:blank lineblank line
No. of Shares:Voting blank line
Non-Voting blank line
Are these shares or any of them held subject to a trust?
Yes blank line No blank line
Shareholder an ineligible person (as defined in the RegulationFootnote for *)?
Yes blank line No blank line
If a Corporation, Corporation access no. blank line

If (We) blank line of blank line solemnly declare that I am blank line (President, Secretary, Director, Officer, Solicitor) of the Corporation and that the information set forth above is correct as of the date of this declaration and I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under Oath.

(Severally) Declared before me blank line

at the blank line of blank line

in the province of blank line this day

of blank line 19 blank line .

blank line
(Signature)

blank line

(A Commissioner for Oaths)

blank line

(Print Name)

blank line

(Signatory’s position with the Corporation)

Date blank line

  •  SOR/82-544, s. 2
 
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