LESAForm 14

							                                                                                                 Form 14
                                                                                                 [Rule 3.36(1)]

COURT FILE NUMBER
                                                                                                Clerk’s Stamp
COURT                               COURT OF QUEEN’S BENCH OF ALBERTA

JUDICIAL CENTRE

PLAINTIFF(S)

DEFENDANT(S)

DOCUMENT                            NOTING IN DEFAULT


ADDRESS FOR SERVICE AND
CONTACT INFORMATION OF
PARTY FILING THIS DOCUMENT

[Name and Status] require(s) the court clerk to enter in the court record of this action a note to the effect that
[Name and Status] has/have not filed a statement of defence and consequently is/are noted in default.