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2. Landowner(s) Information
4. Name:
6. Mailing Address:
8. Postal Code:
9. Telephone:
11. Email:
13. Legal Land Description (include Plan, Block & Lot if applicable):
15. Quarter:
16. Section:
17. Township:
18. Range:
20. West of the ____ Meridian
21. Plan:
22. Block:
23. Lot:
25. Additional Card Holder's Information:
27. Name:
29. Telephone:
31. By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    I, the landowner agree to be responsible for any charges associated with the card issued to the above Legal Land Description till the expiry date listed on the issued card.

    1. I Agree
33. Signature:
35. The personal information on this form is collected under the authority of Section 33 (c) of the Alberta Freedom of Information and Protection of Privacy Act. If you have any questions about the collection contact the County of Wetaskiwin Office at (780) 352-3321.
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field