Form A.2 - Foreign Ownership Of Land Regulations Page 2

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FOL-1
This is Appendix “A” to the Statutory Declaration of
FORM A.2
20
declared before me on the
day of
,
year
A Commissioner for Oaths in and for Alberta
NOTE:
This Appendix is necessary only for a corporation with share capital. Limited Partnerships, Banks, Trust Companies and
Insurance Companies do not have to complete this Appendix
SHAREHOLDERS
Non-foreign
To the best of my
List of Shareholders owning 5% or
controlled
knowledge the
more of the outstanding shares:
corporation,
shareholder is the
Number
% of Total
Canadian
Beneficial Owner
and Class
Outstanding
Citizen or
and controls the
of Shares
Shares
Permanent
rights attached to
Name and Full Address
1
Resident
the shares
2
YES or NO
YES or NO
Additional Appendices
Permanent Resident(s) Requirements
1
If a permanent resident(s), the following information is required:
Date Landed: (M/D/Y)
, Port of Entry:
Birth Date: (M/D/Y)
, and his (her or their) previous country of permanent residency
Landing Information
was:
.
Consent of Permanent Resident(s) Schedule
2
If any of the shares are held in trust or any of the rights attached to the shares are controlled through a contract or other arrangement by a person
who does not own the share then list the person(s), who is (are) the ultimate beneficial owner(s) or who controls the rights attached to the shares,
stating his (her or their) citizenship status and if a permanent resident the information as in the one above.
List of Beneficial Owners of, or owners of the rights attached to, 5% or more of the outstanding shares:
Name
Address
Citizenship Status
This information is being collected to determine eligibility to acquire an interest in controlled land pursuant to the provisions of the Agricultural and
Recreational Land Ownership Act, the Foreign Ownership of Land Regulations and the Land Titles Act. Questions may be directed to: Director, Foreign
rd
Ownership of Land Administration, 3
Floor, John E. Brownlee Building, 10365 - 97 Street, Edmonton, Alberta T5J 3W7, Telephone: (780) 427-6584,
Fax: (780) 427-0938.
REG 0024 (99/06)
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