COURT FILE NUMBER Clerk’s Stamp
COURT PROVINCIAL COURT OF ALBERTA
COURT OF QUEEN’S BENCH
DOCUMENT STATEMENT – COURT DIRECTION
ADDRESS FOR SERVICE AND
CONTACT INFORMATION OF
PARTY FILING THIS
I, [name], swear/affirm that:
1. I am a guardian of the child(ren) and I was appointed a guardian by:
the Court. (attach copy of Order)
a will or a deed. (attach copy of will or deed)
2. My relationship to the child(ren) is [father, aunt, etc.].
3. To the best of my knowledge, I have listed all the current guardians of the child(ren) as
Respondents in this application.
4. The child(ren) reside(s) with [name and relationship to the child(ren)].
5. I ask the Court to provide direction (guidance) about the following question(s) affecting the
6. I have the following other information in support of my application: [specify]
Sworn/Affirmed before me on [date], 20[year] )
at [city], Alberta. )
_____________________________________ ) _______________________________________
Justice of the Peace or Commissioner ) Applicant’s Signature
for Oaths in and for the Province of Alberta )