FORM 40 (Section 629)
Challenge To Array
Canada,
Province of ,
(territorial division).
The Queen
v.
C.D.
The (prosecutor or accused) challenges the array of the panel on the ground that X.Y., (sheriff or deputy sheriff), who returned the panel, was guilty of (partiality or fraud or wilful misconduct) on returning it.
Dated this day of A.D. , at .
Counsel for (prosecutor or accused)