Notice Of Address Change Of Address
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Notice of Address/
RETURN THIS FORM TO:
Change of Address
Service Alberta
Consumer Services Division
Cooperatives Act
3rd Floor, 10155 102 Street
Sections 27(4), 274(1), 278(5) and 279(7)
EDMONTON AB T5J 4L4
Fax No.: (780) 427-3033
PLEASE PRINT OR TYPE
For new cooperatives, continuances or amalgamations, Items 1 and 3 must be completed, and if applicable Items 4, 5, 6 and 7.
For a change of address, Items 1 and 2 must be completed; as well as Item 3, 4, 5, 6, or 7, where applicable.
1. Name of Cooperative
2. Alberta Corporate Access Number
(as noted on registration documents)
3. Address of Registered Office
(This address must be accessible for service to the public during normal business hours.)
Street
City/Town
Province
Postal Code
AB
(If you give a legal description, you must complete Item 7, giving a mailing address.)
Legal Land Description (Section/ Township/ Range/ Meridian or Plan/ Block/ Lot)
OR
4. Telephone Number
Facsimile Number
5. Email Address
(if applicable)
(include area code)
(include area code)
6. Records Address
(Only to be completed if the records are kept somewhere other than at the registered office above.)
(This address must be accessible for service to the public during normal business hours.)
Street (P.O. Box number cannot be used)
City/Town
Province
Postal Code
AB
(If you give a legal description, you must complete Item 7, giving a mailing address.)
Legal Land Description (Section/ Township/ Range/ Meridian or Plan/ Block/ Lot)
OR
7. Address for Service by Mail
(ONLY to be completed if the Cooperative uses a post office address for mail delivery.)
NOTE: If this is a change of address, and Item 7 no longer applies, you must enter "N/A" in this space, otherwise your
mail will continue to be sent to your old post office address.
Post Office Box Only
City/Town
Province
Postal Code
AB
Signature of Authorized Person
Title
Date
(please PRINT)
(mm/dd/yyyy)
Name
Daytime Telephone Number
(please PRINT)
(include area code)
This information is being collected for the purposes of corporate registry records in accordance with the Cooperatives Act. Questions about the collection of this information
can be directed to the Freedom of Information and Protection of Privacy Coordinator for the Alberta Government, Box 3140, Edmonton, Alberta T5J 2G7, (780) 427-5210.
SA0091 (2002/03)
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