6 - DeclarationI hereby certify that I have the relevant knowledge of the cooperative and that I am authorized to sign this form.

SignaturePrint name

Note: Every person who knowingly contravenes this Act or who does not fulfil a duty imposed under this Act is guilty of an offence punishable on summary conviction (Section 349 of the Canada Cooperatives Act).

IC 2655E (2016-01)

1 - Name of the cooperative

Canada Cooperatives Act Form 3022

ANNUAL RETURN

3 - Year of filing

4 - Date of last annual meeting

Yes No

5 - Does the cooperative distribute its securities to the public?

-

2 - Cooperative number

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Symbole du Canada

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6 - Declaration

Declaration

I hereby certify that I have the relevant knowledge of the cooperative and that I am authorized to sign this form.

I hereby certify that I have the relevant knowledge of the cooperative and that I am authorized to sign this form.

Signature

Signature de l'administrateur.

Note: Every person who knowingly contravenes this Act or who does not fulfil a duty imposed under this Act is guilty of an offence punishable on summary conviction (Section 349 of the Canada Cooperatives Act).

IC 2655E (2016-01)

The identification number of form 3022 is IC 2655E - July 2013.

Canada Cooperatives Act

Form 3022

 ANNUAL RETURN

 

Canada Cooperatives Act (Coop Act)Form 3022 ANNUAL RETURN(Section 374)

5 - Does the cooperative distribute its securities to the public? 

Does the cooperative distribute its securities to the public?

2 - Cooperative number

Cooperative number

E

Guy Chaussé and Gary Kenny

August 2008

Industry Canada

FORM 3022 - ANNUAL RETURN

Nancy Mathieu

IC2655E - ANNUAL RETURN

November 2015

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