3-ec20010 e candidate nomination paper

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NOMINATION PAPER

OF A CANDIDATE AT A FEDERAL ELECTION OR BY-ELECTION

(As required under section 66 of the Canada Elections Act)

TO BE FILED AFTER THE ISSUE OF THE NOTICE OF ELECTIONPURSUANT TO SUBSECTION 67(1) OF THE CANADA ELECTIONS ACT

Please read the instructions on pages 3 and 4 carefully before completing this document.

EC 20010(10/07)

PROTECTED WHEN COMPLETED


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CONTENTS

Page

Instructions for completion of this Nomination Paper 3-4

Part 1 Candidate, Official Agent and Auditor 1

Part 2 Candidates Consent to Nomination and Designation of Official Agent and Auditor 5

Part 3 Declaration of Official Agent 6

Part 4 Oath of Witness to Consent of Candidate 7

Part 5 Receipt for Nomination Paper and for Deposit 9

Part 6 Notice of Confirmation or Refusal of Nomination 11

Part 7 Electors Consenting to Candidacy 13-28

The Nomination Paper of a confirmed candidate may only be disclosed in accordance with the Canada Elections Act. The personal information provided

is otherwise protected under the Canada Elections Actand the Privacy Act. The information is retained in Personal Information Bank CEO PPU 005.The Nomination Paper of a confirmed candidate must remain in the office of the returning officer at all times during the election period and may

be examined by any person during that period of time.


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6

I, the undersigned, official agent for the candidate nominated in this Nomination Paper, declare that:

I hereby agree to act as official agent for the candidate named herein for the purposes of the Canada Elections Act;

I am fully aware of the duties and responsibilities imposed on me by the Canada Elections Act;

I am capable of entering into contracts in the province/territory in which this electoral district is located; and

I am eligible to act as official agent pursuant to section 84* of the Canada Elections Act.

DECLARED AT this day of 20

Signature of official agent

*Section 84 of the Canada Elections Actstates that: The following persons are not eligible to be an official agent: a candidate; an election officer or a member of the staff of a returning officer; an undischarged bankrupt; an auditor appointed as required by this Act; a person who is not qualified as an elector; and a person who does not have the capacity to enter into contracts

in the province in which he or she ordinarily resides.

ELECTORAL DISTRICT CANDIDATE

PART 3 DECLARATION OF OFFICIAL AGENT


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PART 4 OATH OF WITNESS TO CONSENT OF CANDIDATE*

(To be taken before the returning officer at the time of the filing of the Nomination Paper)

I, the undersigned, whose name appears above, swear or solemnly affirm that:

I know the person nominated in this Nomination Paper;

The consent to nomination was signed in my presence; and

I am qualified as an elector (at least 18 years old on election day and a Canadian citizen).

Pursuant to subsection 67(2) of the Canada Elections Act, I further declare that I used due diligence to ensure that the signatures on the Nomination Paper were

all made by electors resident in the electoral district of

(Name of electoral district)

Signature of witness**(The person who signed as witness to the oath and consent of

nominated candidate on page 5 must sign here.)

SWORN OR AFFIRMED BEFORE ME At this day of 20

Signature of returning officer

*Pursuant to subsection 73(1) of the Canada Elections Act, this oath does not have to be completed when the Nomination Paper is sent by electronic means.**It is an offence under section 499 and subsection 549(3) of the Act to take falsely an oath that is provided under this Act.

NAME OF WITNESS ADDRESS


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DATE


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PART 5 RECEIPT FOR NOMINATION PAPER AND FOR DEPOSIT

RECORD OF RECEIPT ISSUED BY THE RETURNING OFFICER

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RECEIPT FOR NOMINATION PAPER AND DEPOSIT

I acknowledge receipt of the sum of one thousand (1,000) dollars on behalf of the candidate named herein, being the deposit for a candidate at this federalelection, together with the Nomination Paper of this candidate. This receipt is not a confirmation that the candidates nomination has been accepted.

NOTE: The deposit will be returned: if the nomination is refused; on compliance with post-election reporting requirements; or if the candidate dies before all pollingstations close.


CANDIDATE

Time

Remove receipt at this perforation

Date Signature of returning officer

ELECTORAL DISTRICT

The Nomination Paper of a confirmed candidate may only be disclosed in accordance with the Canada Elections Act. The personal information provided

is otherwise protected under the Canada Elections Actand the Privacy Act. The information is retained in Personal Information Bank CEO PPU 005.The Nomination Paper of a confirmed candidate must remain in the office of the returning officer at all times during the election period and may


ISSUED TO (NAME OF PERSON)TIME DATE


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TIME

POLITICALAFFILIATION

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PART 6 NOTICE OF CONFIRMATION OR REFUSAL OF NOMINATION*

(To be provided by the returning officer to the prospective candidate once the reviewof the Nomination Paper has been completed)

*The returning officer must keep a photocopy of this page with the Nomination Paper filed for the above candidate.

Pursuant to subsection 71(3) of the Canada Elections Act, a Nomination Paper that has been refused may be replaced by another Nomination Paper or may be

corrected. The new or corrected Nomination Paper must, however, be filed with me by the close of nominations (at 2:00 p.m. on the 21st day before election day).

I will review any new or corrected Nomination Paper that you may choose to file with me within 48 hours of receipt.

Beyond the close of nominations, should this Nomination Paper not meet the requirements of the Canada Elections Act, the nomination of the above candidate

will no longer be considered for this federal election.

Pursuant to subsection 71(1) of the Canada Elections Act,

I hereby confirm the nomination of this candidate.

I hereby refuse to accept the nomination of this candidate for the following reason(s):


DATE

Remove at perforation

RETURNING OFFICERS SIGNATURE


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PART 7 ELECTORS CONSENTING TO CANDIDACY

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SIGNATURE

WITNESS TO ABOVE SIGNATURES

Any person qualified as an elector and ordinarily resident in the electoral district in which the candidate named on page 1 is seeking nomination may sign this Nomination Paper,

whether or not the electors name appears on a list of electors. Your signature signifies that you are consenting to this candidacy.

NOTES: The witness or witnesses to the signature supporting a candidate are not required to be qualified as electors in any electoral district.The signatures on this page must all be witnessed by the same person.

NAME FULL ADDRESS

NAME

(please print in block letters)

FULLADDRESS


SIGNATUREI, the undersigned, declare that I am a Canadian citizen,

that I will be at least 18 years of age on election day and thatI ordinarily reside (see instruction #7) in this electoral district.

INITIALS

OF

WITNESS

SEX(Optional)

(M or F)


The Nomination Paper of a confirmed candidate may only be disclosed in accordance with the Canada Elections Act. The personal information providedis otherwise protected under the Canada Elections Actand the Privacy Act. The information is retained in Personal Information Bank CEO PPU 005.

The Nomination Paper of a confirmed candidate must remain in the office of the returning officer at all times during the election period and may


CANDIDATE:


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SIGNATURE





NAME FULL ADDRESS

NAME


FULLADDRESS




INITIALS

OF

WITNESS

SEX(Optional)

(M or F)





CANDIDATE:


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SIGNATURE





NAME FULL ADDRESS

NAME


FULLADDRESS




INITIALS

OF

WITNESS

SEX(Optional)

(M or F)





CANDIDATE:


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SIGNATURE





NAME FULL ADDRESS

NAME


FULLADDRESS




INITIALS

OF

WITNESS

SEX(Optional)

(M or F)





CANDIDATE:


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SIGNATURE





NAME FULL ADDRESS

NAME


FULLADDRESS




INITIALS

OF

WITNESS

SEX(Optional)

(M or F)





CANDIDATE:


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SIGNATURE





NAME FULL ADDRESS

NAME


FULLADDRESS




INITIALS

OF

WITNESS

SEX(Optional)

(M or F)





CANDIDATE:


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SIGNATURE





NAME FULL ADDRESS

NAME


FULLADDRESS




INITIALS

OF

WITNESS

SEX(Optional)

(M or F)





CANDIDATE:


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SIGNATURE





NAME FULL ADDRESS

NAME


FULLADDRESS




INITIALS

OF

WITNESS

SEX(Optional)

(M or F)





CANDIDATE:


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SIGNATURE





NAME FULL ADDRESS

NAME


FULLADDRESS




INITIALS

OF

WITNESS

SEX(Optional)

(M or F)





CANDIDATE:


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SIGNATURE





NAME FULL ADDRESS

NAME


FULLADDRESS




INITIALS

OF

WITNESS

SEX(Optional)

(M or F)





CANDIDATE:


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SIGNATURE





NAME FULL ADDRESS

NAME


FULLADDRESS




INITIALS

OF

WITNESS

SEX(Optional)

(M or F)





CANDIDATE:

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SIGNATURE





NAME FULL ADDRESS

NAME


FULLADDRESS




INITIALS

OF

WITNESS

SEX(Optional)

(M or F)





CANDIDATE:


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SIGNATURE





NAME FULL ADDRESS

NAME


FULLADDRESS




INITIALS

OF

WITNESS

SEX(Optional)

(M or F)





CANDIDATE:

27


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SIGNATURE





NAME FULL ADDRESS

NAME


FULLADDRESS




INITIALS

OF

WITNESS

SEX(Optional)

(M or F)





CANDIDATE:

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SIGNATURE





NAME FULL ADDRESS

NAME


FULLADDRESS




INITIALS

OF

WITNESS

SEX(Optional)

(M or F)





CANDIDATE:

3-ec20010 e candidate nomination paper

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