CPA · Residential Tenancies Ministerial Regulation
15 Coming into force
Schedule AR 211/2004
Schedule
Form 1
This notice may be used by a landlord to terminate a periodic
tenancy.
Landlord's Notice to Tenant
Termination of a Periodic Tenancy
TO: (name of tenant)
(address, including postal code)
I give you notice that the periodic tenancy between me as landlord
and you as tenant for (identify the premises) is terminated
on (date) . You are required to vacate the premises
by (time) on that date. (Section 20 of the Residential Tenancies
Act states that a tenancy terminates at 12 noon on the last day of the
tenancy unless the landlord and tenant agree to a different time.)
The tenancy is being terminated for the following reason(s):
Dated this day of , 20 .
(signature of landlord or landlord's agent)
(print name of landlord or landlord's agent)
(address, including postal code)
(telephone)
Form 2
This notice may be used by a tenant to terminate a periodic
tenancy.
Tenant's Notice to Landlord
Termination of a Periodic Tenancy
TO: (name of landlord)
(address, including postal code)
I give you notice that the periodic tenancy between me as tenant
and you as landlord for (identify the premises) is terminated
on (date) . I will give up possession of the premises
by (time) on that date. (Section 20 of the Residential Tenancies
Act states that a tenancy terminates at 12 noon on the last day of the
tenancy unless the landlord and tenant agree to a different time.)
Schedule AR 211/2004
Dated this day of , 20 .
(signature of tenant or tenant's agent)
(print name of tenant or tenant's agent)
(address, including postal code)
(telephone)
Form 3
This notice may be used by a landlord to terminate a tenancy under
section 29 of the Act when the tenant commits a substantial breach
of the tenancy agreement.
Landlord's Notice to Tenant
Termination of Tenancy for Substantial Breach
TO: (name of tenant)
(address, including postal code)
I give you notice that the tenancy between me as landlord and you
as tenant for (identify the premises) is terminated on (date) .
You are required to vacate the premises by (time) on that date.
(Section 20 of the Residential Tenancies Act states that a tenancy
terminates at 12 noon on the last day of the tenancy unless the
landlord and tenant agree to a different time.)
The tenancy is being terminated because you have committed the
following act(s) which constitutes a substantial breach of our
residential tenancy agreement:
Dated this day of , 20 .
(signature of landlord or landlord's agent)
(print name of landlord or landlord's agent)
(address, including postal code)
(telephone)
● This notice must be served on the tenant at least 14 days
before the day that the tenancy is to terminate.
● If this notice is for the non-payment of rent, the tenancy will
not be terminated if, on or before the termination date
specified in this notice, the tenant pays the rent due and any
additional rent that has become due under the residential
tenancy agreement as of the date of payment.
Schedule AR 211/2004
Form 4
This notice may be used by a landlord to terminate a tenancy under
section 30 of the Act when the tenant has
(a) done or permitted significant damage to the residential
premises, the common areas or the property of which they
form a part, or
(b) physically assaulted or thre atened to physically assault the
landlord or another tenant.
Landlord's Notice to Tenant
24-hour Notice of Termination of Tenancy
TO: (name of tenant)
(address, including postal code)
I give you notice that the tenancy between me as landlord and you
as tenant for (identify the premises) is terminated on (date) .
You are required to vacate the premises by (time) on that date.
The tenancy is being terminated for the following reason(s):
Dated this day of , 20 .
(signature of landlord or landlord's agent)
(print name of landlord or landlord's agent)
(address, including postal code)
(telephone)
Form 5
This notice may be used by a landlord to require a person who is
not a tenant but who is living in residential premises to vacate those
premises when
(a) the tenant has abandoned the premises, pursuant to section
33 of the Act, or
(b) the premises are occupied by a tenant, pursuant to section
36 of the Act.
Landlord's Notice to Vacate
to Person(s) who are Not Tenants
TO: (name of person(s) required to vacate)
(address, including postal code)
Schedule AR 211/2004
I give you notice that you are required to vacate (identify the
premises) on (date) by (time) . You are required to vacate for
the following reason:
Dated this day of , 20 .
(signature of landlord or landlord's agent)
(print name of landlord or landlord's agent)
(address, including postal code)
(telephone)
Form 6
This notice may be used by a tenant to terminate a tenancy under
section 28 of the Act when the landlord commits a substantial
breach of the tenancy agreement and the specified conditions under
section 28 have been met.
Tenant's Notice to Landlord
Termination of Tenancy for Substantial Breach
TO: (name of landlord)
(address, including postal code)
I give you notice that the tenancy between me as tenant and you as
landlord for (identify the premises) is terminated on (date) . I
will vacate the premises by (time) on that date. (Section 20 of
the Residential Tenancies Act states that a tenancy terminates at 12
noon on the last day of the tenancy unless the landlord and tenant
agree to a different time.)
The tenancy is being terminated because you have committed the
following substantial breach:
Dated this day of , 20 .
(signature of tenant or tenant's agent)
(print name of tenant or tenant's agent)
(address, including postal code)
(telephone)
● This notice must be served on the landlord at least 14 days
before the day that the tenancy is to terminate.
Schedule AR 211/2004
Form 7
This form must be used by the designated authority to certify that
there are grounds to terminate a tenancy under section 47.3 of the
Act when the designated authority has
(a) completed the necessary assessment, and
(b) is satisfied that, if the tenancy continues, there is a risk to
the safety of the tenant, the tenant's dependent child or a
protected adult who lives with the tenant.
The notice and certificate included in this form are for use to effect
service on the landlord as required by section 47.3(2) of the Act.
Certificate Confirming Grounds to
Terminate Tenancy
(Certificate Number: )
Section 1 - Tenant Information
Please complete this section for the tenant applying for the
certificate
(name of tenant)
(address of the tenancy to be terminated, including postal code)
□ Dependent child(ren) or protected adult(s) reside in the
tenants' care.
Section 2 - Additional Tenants' Information
(names of additional tenants)
(current address, if known, including postal code)
(names of additional tenants)
(current address, if known, including postal code)
Section 3 - Designated Authority Declaration
By signing my name below I certify that, having completed the
assessment of information received from the tenant, I am satisfied
that there is a risk to the safety of the tenant, the tenant's dependent
child or a protected adult who lives with the tenant if the tenancy
continues, and that as such there are grounds to terminate the
tenancy identified in section 1.
Dated this day of , 20 .
(signature of designated authority)
(print name of designated authority)
Schedule AR 211/2004
NOTICE TO LANDLORD
This notice and certificate are valid if served within 90 days after
the date on which the designated authority declaration (section 3)
was signed.
You may be required to notify the other tenants listed on the
certificate that the tenancy will terminate for all the tenants in the
premises. However, you and the additional tenants may agree to
enter into a new landlord and tenant relationship.
You are required by law to ensure that any information that you
receive from or about the tenant named above that is related to this
notice and certificate is kept confidential unless you are authorized
under the Termination of Tenancy (Domestic Violence) Regulation
to disclose that information. You can access the Regulation on the
website of Alberta King's Printer at:
http://alberta.ca/alberta-kings-printer.aspx.
You may apply to a court or the Residential Tenancy Dispute
Resolution Service to set aside a notice to terminate only on the
ground that the notice to terminate and the certificate were not
properly served as required by section 47.3 of the Residential
Tenancies Act.
If you have questions about this certificate, please contact the
Service Alberta contact centre at 780-427-4088 (Edmonton and
area) or 1-877-427-4088 (toll free in Alberta).
AR 211/2004 Sched.;118/2016;218/2022
Printed on Recycled Paper
*9780779863686*