Form 49

[Rule 13.19]
COURT FILE NUMBER

COURT

COURT OF QUEENS BENCH OF ALBERTA

JUDICIAL CENTRE

PLAINTIFF(S)

DEFENDANT(S)

DOCUMENT

AFFIDAVIT

ADDRESS FOR SERVICE AND

CONTACT INFORMATION OF
PARTY FILING THIS DOCUMENT

Clerks Stamp

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
of Alberta)

______________________________________
PRINT NAME AND EXPIRY/LAWYER
/STUDENT-AT-LAW

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___________________________________
(Signature)

___________________________________
(Print Name)

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