(Name of proposed private Act here)
NOTICE is hereby given that petitions will be submitted by [John and Mary Smith] to the Lieutenant Governor and the Legislative Assembly of the Province of Alberta for the passage of a Bill that (State the object desired by the petitioner in soliciting a private Act).
Any person whose rights or property are materially affected by the proposed legislation may contact the Legislative Assembly in writing no later than the 15th day following the first day of the first sitting in a year should they wish to make a representation
relevant to this application. Correspondence should be addressed to the Office of Parliamentary Counsel, 3rd Floor, 9820 - 107 Street NW, Edmonton, Alberta, T5K 1E7. Telephone 780.422.4837. Fax 780.427.0744.
DATED at the City of Edmonton, in the Province of Alberta, this ____ day of ______________, 20__.
(Name(s) and address(es) of petitioner(s) or petitioner’s counsel)