Environment and
Sustainable Resource Development
Tender Bid Submission
Farm Holdings Consolidation Program
5th Floor, South Petroleum Plaza
9915 - 108 Street
Edmonton, Alberta, T5K 2G8
For Departmental Use Only
Application Number:
PLS
Client I.D. Number:
APPLICANT'S FULL SURNAME & GIVEN NAMES OR CORPORATION NAME
I/We
NOTE: If this bid submission is accepted, title will be issued only in the name(s) listed above. No changes will be accepted.
If title is to be held in more than one name, please indicate if it is to be held as:
Joint Tenants or
Tenants in Common
FULL MAILING ADDRESS AND POSTAL CODE
TELEPHONE NUMBER
of
(
)
HEREBY SUBMIT THE FOLLOWING TENDER FOR (LEGAL DESCRIPTION):
This section to be completed by individual bidders only.
Corporate and Association bidders must complete the declaration on the back of this page.
I am/We are
1.
Canadian Citizen(s) or
Permanent Resident(s) of Canada
Yes
18 years of
age or older
No
Provincial Government Employee(s)
(If yes, attach approval pursuant to Public Service Act.)
Yes
No
Yes
2.
I/We meet all other requirement(s) outlined in the public notice relating to the tender.
3.
I/We hereby tender the amount of $
4.
$
amount being tendered.
5.
GST Registrant
No
as purchase price for the above land.
is enclosed in the form of a certified cheque or postal/bank money order to cover 10% of the
Yes
No
GST Registration Number
BIDDER(S) SIGNATURE
BIDDER(s) SIGNATURE
Please use envelope provided (LG 113)
NOTE: GST is payable on the total purchase price and (if applicable) on the value of any privately owned improvements, upon
final acceptance of a bid, unless the successful bidder is a registrant under the Goods and Services Tax.
Should a bid be declared accepted, and it is established later that the successful bidder did not meet the
requirement(s) outlined in the public notice, the sale may be cancelled, and the 10% deposit forfeited.
For Departmental Use Only
Tender Opening
Date:
Amount Bid: $
Opened By:
Decision:
Amount Enclosed: $
Witness:
Refused
Accepted
Signature For Minister Of Environment and Sustainable Resource Development
Unsuccessful Bidder
Cheque/Money Order Returned
Successful Bidder
10% Down Payment (received)
$
GST on Total Purchase Price
$
Administration Fee & GST
$
Privately Owned Improvements
$
GST on Privately Owned Improvements
$
TOTAL
$
Less Amount Received
$
Total Owing
$
Personal information taken in this application is collected in accordance with Section 33(a)(c) of the Freedom of Information and Protection of Privacy Act and Section 1 of the
Dispositions and Fees Regulation. Sustainable Resource Development (SRD) collects, uses and discloses personal information in accordance with Part 2 of the FOIP Act and
the Dispositions and Fees Regulation. Should you require further information about the collection, use and disclosure of personal information contact SRD at (780) 427-3570.
Nov 2013
FHCP-Tender Bid Submission
© 2013 Government of Alberta
Page 1 of 2
Public Land Sales - Tender Bid Submission
To Be Completed By Bidder For Corporation
Declaration
NAME
I/We,
ADDRESS
in the Province of Alberta do solemnly declare that:
of
I am an agent of the above corporation.
I hold the office of
given herein.
in the said corporation and have a personal knowledge of the information
The above is a Canadian Corporation as defined in the Public Lands Act.
In addition, I meet all other requirements outlined in the public notice relating to the tender of the land described above.
The information given herein is true and correct.
Declared before me at the
of
in the Province of Alberta
_____________________________________________
this
day of
SIGNATURE OF APPLICANT
, 20
NOTARY PUBLIC , COMMISSIONER FOR OATHS OR JUSTICE OF THE PEACE
IN AND FOR THE PROVINCE OF ALBERTA
PRINTED OR STAMPED NAME OF COMMISSIONER FOR OATHS
AND DATE ON WHICH APPOINTMENT EXPIRES
CANADIAN CORPORATION AS DEFINED BY THE PUBLIC LANDS ACT
Section 22.1 (3)
(a)
“Canadian corporation” means
(i)
in the case of a corporation with share capital, a corporation in which not less than 75% of the equity
shares are registered in the name of and beneficially owned by
(A)
one or more Canadian citizens or permanent residents as defined in the Immigration Act
(Canada),
(B)
one or more corporations with share capital, if in each case not less than 75% of its equity
shares are registered in the name of and beneficially owned by Canadian citizens or
permanent residents as defined in the Immigration Act (Canada),
(C)
one or more corporations without share capital, if in each case not less than 75% of its
members are Canadian citizens or permanent residents as defined in the Immigration Act
(Canada), or
(D)
any combination of persons or corporations referred to in paragraphs (A), (B) and (C),
or
(ii)
(b)
Nov 2013
in the case of a corporation without share capital, a corporation in which not less than 75% of its
members are Canadian citizens or permanent residents as defined in the Immigration Act (Canada);
“equity share” means any share of any class of shares of a corporation carrying full or limited voting rights
and any share of any class of shares of the corporation carrying voting rights by reason of a contingency
that has occurred and is continuing.
FHCP-Tender Bid Submission
© 2013 Government of Alberta
Page 2 of 2