FORM A.1 FORM 1 FOREIGN OWNERSHIP OF LAND REGULATIONS CITIZENSHIP DECLARATION FOR CANADIAN CITIZEN(S) AND PERMANENT RESIDENT(S) [ For Controlled Land ONLY ] Canadian Citizen(s) Permanent Resident(s) IN THE MATTER of the registration of the CANADA (name type of instrument) PROVINCE OF ALBERTA affecting the land described as: TO WIT: (insert abbreviated description) containing (acres or hectares) (name of County, M.D., I.D. or Special Area) ______________________________________________________________________________________________________ of _____________________________________________________________________________________________________________ (Full Address including street, municipality and country) SOLEMNLY DECLARE THAT: 1. ____________________ the ________________________________________________________ named in the above described instrument and will hold the interest in the land beneficially and not as trustee(s) and not on behalf of any person and ____________________ a Canadian citizen(s). or ____________________ the ________________________________________________________ named in the above described instrument and will hold the interest in the land beneficially and not as trustee(s) and not on behalf of any person and ____________________ a permanent resident(s) within the meaning of the Immigration Act, 1976 (Canada). Date Landed: (M/D/Y) , Port of Entry ________________________________________ Birth Date: (M/D/Y) , and my/our previous country of permanent residency was: . or I am a member of the Law Society of Alberta and am the solicitor for the _________________________________________________ named in the above described instrument who will hold the interest in the land beneficially and not as trustee(s) and not on behalf of any person and who is (are) a Date Landed: (M/D/Y) , Port of Entry ________________________________________ Birth Date: (M/D/Y) , and his (her or their) previous country of permanent residency was: . REG0023 (2008/07)