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– 2 – Form 44 [Rule 10.35(1)] COURT FILE NUMBER Clerk’s Stamp       COURT COURT OF QUEEN’S BENCH OF ALBERTA JUDICIAL CENTRE       PLAINTIFF(S)       DEFENDANT(S)       DOCUMENT BILL OF COSTS ADDRESS FOR SERVICE AND CONTACT INFORMATION OF PARTY FILING THIS DOCUMENT       BILL OF COSTS OF [NAME AND STATUS] Fees claimed: ITEM NO. ITEM AMOUNT               $                     $                   $       Taxable Disbursements (subject to GST): DESCRIPTION AMOUNT       $             $             $       Non-taxable Disbursements (not subject to GST): DESCRIPTION AMOUNT       $             $             $       Other Charges: DESCRIPTION AMOUNT       $             $             $       GST: (a) Amount claimed on fees: $       (b) Amount claimed on disbursements: $       (c) Amount claimed on other charges: $       TOTAL GST: $       By making the above claim for an additional amount on account of goods and services tax, the party entitled to the costs award warrants that it is not entitled under the Excise Tax Act (Canada) to a refund or rebate of any goods and services tax paid. Total amount claimed: Fees: $       Taxable Disbursements: $       Non-taxable Disbursements: $       Other Charges: $       GST: $       TOTAL: $       Amount allowed by assessment officer: Fees: $       Taxable Disbursements: $       Non-taxable Disbursements: $       Other Charges: $       GST: $       TOTAL: $       Person responsible for preparation of this Bill of Costs: _______________________________________ Signature _______________________________________ Print Name CERTIFICATE OF ASSESSMENT OFFICER: I, , certify the following amount(s) that is (are) to be paid By Plaintiff: $       By Defendant: $       to:       (name of party or parties to receive the costs awarded). I also certify the following special circumstance(s) and the amount to be paid by each party with respect to the special circumstance(s): Dated:       Signature of Assessment Officer: