Form 31

FORM 31 (Section 540)

Deposition of a Witness

Canada,

Province of ,

(territorial division).

These are the depositions of X.Y., of , and M.N., of , taken before me, this  day of  A.D.,  at , in the presence and hearing of A.B., hereinafter called the accused, who stands charged (state offence as in the information).

X.Y., having been duly sworn, deposes as follows: (insert deposition as nearly as possible in words of witness).

M.N., having been duly sworn, deposes as follows:

I certify that the depositions of X.Y., and M.N., written on the several sheets of paper hereto annexed to which my signature is affixed, were taken in the presence and hearing of the accused (and signed by them respectively, in his presence where they are required to be signed by witness). In witness whereof I have hereto signed my name.

A Justice of the Peace in and for 

Form 32

FORM 32 

(Sections 2, 462.‍34, 490.‍9, 550, 683, 706, 707, 779, 810, 810.‍01, 810.‍1, 810.‍2, 817 and 832)

Recognizance

Canada,

Province of .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.

(territorial division)

1 Identification

Surname: .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍. Given name(s): .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.

Date of birth: .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.

Home address: .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.

Phone number(s): .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍(primary).‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍. (other)

Other contact information (if any): .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.

Employment or Occupation (if any): .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.

Name and contact information of employer (if any): .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.

2 Financial Promise or Deposit

Pursuant to .‍.‍.‍. (provision) of the Criminal Code, I agree to (promise or deposit) the amount of $ .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍, or the other valuable security described here:.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.

I understand that if I fail to comply with any of the conditions listed below, this amount or security may be forfeited.

3 Conditions

(List the conditions that have been ordered by the court and indicate the duration for which each condition remains in effect.)

.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.

4 Variation

I understand that I may apply to a judge or a justice of the peace to have any condition in this form cancelled or varied.

5 Conditions in effect

I understand that the conditions in this recognizance remain in effect until they are cancelled or changed or until I have been discharged, sentenced or otherwise detained by the court (sections 763 and 764 of the Criminal Code).

6 Signatures

PERSON WHO IS GIVING RECOGNIZANCE:

I understand the contents of this form and agree to comply with the conditions that are listed above.

Signed on .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍. (date), at .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍(place).

(Signature of the person)

(Print name)

SURETY (if applicable):

I understand my role and my responsibilities under this recognizance and I agree to act as a surety.

I agree to (promise or deposit) as security to the court the amount of $.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.

I understand that if the person who is giving this recognizance fails to comply with any of the conditions in this recognizance, the money that I have promised or deposited may be forfeited.

Surety Declaration (if applicable)

□ Surety Declaration attached. (Section 515.‍1 of the Criminal Code.‍)

□ Surety excepted from providing Surety Declaration. (Subsection 515.‍1(2) of the Criminal Code.‍)

Signed on .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍. (date), at .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍(place).

(Signature of the Surety)

(Print name)

JUDGE, PROVINCIAL COURT JUDGE, JUSTICE OR CLERK OF THE COURT:

Signed on .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍. (date), at .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍(place).

(Signature of the judge, provincial court judge, justice or clerk of the court)

(Print name)

List of Conditions

(a) has a surety (sections 462.‍34, 490.‍9, 550, 779, 810, 817 and 832 of the Criminal Code);

(b) agrees to keep the peace and be of good behaviour (sections 83.‍3, 810, 810.‍01, 810.‍1 and 810.‍2 of the Criminal Code);

(c) abstains from possessing a firearm, crossbow, prohibited weapon, restricted weapon, prohibited device, ammunition, prohibited ammunition or explosive substance and surrenders those in their possession and surrenders any authorization, licence or registration certificate or other document enabling the acquisition or possession of a firearm (sections 83.‍3, 810, 810.‍01, 810.‍1 and 810.‍2 of the Criminal Code);

(d) participates in a treatment program (sections 810.‍01, 810.‍1 and 810.‍2 of the Criminal Code);

(e) wears an electronic monitoring device (if the Attorney General makes the request) (sections 810.‍01, 810.‍1 and 810.‍2 of the Criminal Code);

(f) remains within a specified geographic area unless written permission to leave that area is obtained from the judge (sections 810.‍01 and 810.‍2 of the Criminal Code);

(g) returns to and remains at their place of residence at specified times (sections 810.‍01, 810.‍1 and 810.‍2 of the Criminal Code);

(h) abstains from the consumption of drugs, except in accordance with a medical prescription (sections 810.‍01, 810.‍1 and 810.‍2 of the Criminal Code);

(i) abstains from the consumption of alcohol or of any other intoxicating substance, except in accordance with a medical prescription (sections 810.‍01, 810.‍1 and 810.‍2 of the Criminal Code);

(j) abstains from any contact — including communicating by any means — with a person under the age of 16 years, unless doing so under the supervision of a person whom the judge considers appropriate (section 810.‍1 of the Criminal Code);

(k) abstains from using the Internet or other digital network, unless doing so in accordance with conditions set by the judge (section 810.‍1 of the Criminal Code);

(l) abstains from attending a public park or public swimming area where persons under the age of 16 years are present or can reasonably be expected to be present, or a daycare centre, schoolground or playground (section 810.‍1 of the Criminal Code);

(m) appears personally or by counsel at the sittings of the appeal court at which the appeal is to be heard (sections 817 and 832 of the Criminal Code);

(n) appears in court as required (sections 550, 706 and 707 of the Criminal Code);

(o) in the case where a warrant was issued under section 462.‍32 of the Criminal Code or a restraint order was made under subsection 462.‍33(3) of that Act in relation to any property (set out a description of the property and its location), refrains from doing or causing anything to be done that would result, directly or indirectly, in the disappearance, dissipation or reduction in value of the property or otherwise affect the property so that all or a part thereof could not be subject to an order of forfeiture under section 462.‍37 or 462.‍38 of that Act or any other provision of that Act or any other Act of Parliament (section 462.‍34 of the Criminal Code);

(p) agrees to prosecute the writ of certiorari at their own expense, without wilful delay, and, if ordered, to pay to the person in whose favour the conviction, order or other proceeding is affirmed their full costs and charges to be taxed according to the practice of the court where the conviction, order or proceeding is affirmed (section 779 of the Criminal Code);

(q) any other reasonable conditions, including:

– reports at specified times to peace officer or other person designated;

– remains within designated territorial jurisdiction;

– notifies peace officer or other person designated of any change in their address, employment or occupation;

– abstains from communicating, directly or indirectly, with victim, witness or other specified person except in accordance with conditions specified by judge, provincial court judge or justice; and

– deposits all their passports as the judge, provincial court judge or justice directs.

Form 33

FORM 33 

(Section 770)

Certificate of Default to Be Endorsed

It is certified that A.‍B. (has not appeared as required by this undertaking, release order or recognizance or has not complied with a condition of this undertaking, release order or recognizance) and that for this reason the ends of justice have been (defeated or delayed, as the case may be).

The nature of the default is .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍. and the reason for the default is .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍. (state reason if known).

The names and addresses of the principal and sureties are as follows:

Dated (date) , at  (place).

(Signature of judge, provincial court judge, justice, clerk of the court, peace officer or other person)

(Seal, if required)

Form 34

FORM 34 (Section 771)

Writ of Fieri Facias

Elizabeth II by the Grace of God, etc.

To the sheriff of (territorial division), GREETING.

You are hereby commanded to levy of the goods and chattels, lands and tenements of each of the following persons the amount set opposite the name of each:

Name  Address  Occupation  Amount

And you are further commanded to make a return of what you have done in execution of this writ.

Dated this  day of  A.D. , at  .

Clerk of the 

(Seal)

Form 34.1

FORM 34.1 (Subsection 737.1(4))

Statement on Restitution

Canada,

Province of ,

(territorial division).

To the court that is sentencing (name the offender) who was convicted, or was discharged under section 730 of the Criminal Code, of an offence under that Act.

I, (name of declarant), declare that (check the appropriate box):

[ ] (i) I am not seeking restitution for the losses and damages I suffered as the result of the commission of the offence.

[ ] (ii) I am seeking restitution in the amount of $ for the following losses and damages I suffered as the result of the commission of the offence.

I declare that I have suffered the following losses and damages as the result of the commission of the offence:

(Complete the following table if seeking restitution.)

Description

(describe each loss and damage)

Amount of loss and damage

(state the amount of each loss and damage)

I understand that the amount of my losses and damages must be readily ascertainable by the court. For that purpose, I am responsible for providing the court with all necessary documents, including bills, receipts and estimates, in support of my claim for restitution.

Dated this  day of  20, at  .

Signature of declarant

Form 34.2

FORM 34.2 (Subsection 722(4))

Victim Impact Statement

This form may be used to provide a description of the physical or emotional harm, property damage or economic loss suffered by you as the result of the commission of an offence, as well as a description of the impact of the offence on you. You may attach additional pages if you need more space.

Your statement must not include

 any statement about the offence or the offender that is not relevant to the harm or loss you suffered;

 any unproven allegations;

 any comments about any offence for which the offender was not convicted;

 any complaint about any individual, other than the offender, who was involved in the investigation or prosecution of the offence; or

 except with the court’s approval, an opinion or recommendation about the sentence.

You may present a detailed account of the impact the offence has had on your life. The following sections are examples of information you may wish to include in your statement. You are not required to include all of this information.

Emotional impact

Describe how the offence has affected you emotionally. For example, think of

 your lifestyle and activities;

 your relationships with others such as your spouse, family and friends;

 your ability to work, attend school or study; and

 your feelings, emotions and reactions as they relate to the offence.

  Physical impact

Describe how the offence has affected you physically. For example, think of

 ongoing physical pain, discomfort, illness, scarring, disfigurement or physical limitation;

 hospitalization or surgery you have had because of the offence;

 treatment, physiotherapy or medication you have been prescribed;

 the need for any further treatment or the expectation that you will receive further treatment; and

 any permanent or long-term disability.

  Economic impact

Describe how the offence has affected you financially. For example, think of

 the value of any property that was lost or damaged and the cost of repairs or replacement;

 any financial loss due to missed time from work;

 the cost of any medical expenses, therapy or counselling;

 any costs or losses that are not covered by insurance.

Please note that this is not an application for compensation or restitution.

  Fears for security

Describe any fears you have for your security or that of your family and friends. For example, think of

 concerns with respect to contact with the offender; and

 concerns with respect to contact between the offender and members of your family or close friends.

  Drawing, poem or letter

You may use this space to draw a picture or write a poem or letter if it will help you express the impact that the offence has had on you.

 I would like to present my statement in court.

To the best of my knowledge, the information contained in this statement is true.

Dated this  day of  20, at  .

Signature of declarant

If you completed this statement on behalf of the victim, please indicate the reasons why you did so and the nature of your relationship with the victim.

  

  

Dated this  day of  20, at  .

Signature of declarant

In Tags

Form 34.3

FORM 34.3 (Subsection 722.2(2))

Community Impact Statement

This form may be used to provide a description of the harm or loss suffered by a community as the result of the commission of an offence, as well as a description of the impact of the offence on the community. You may attach additional pages if you need more space.

Your statement must not include

 any statement about the offence or the offender that is not relevant to the harm or loss suffered by the community;

 any unproven allegations;

 any comments about any offence for which the offender was not convicted;

 any complaint about any individual, other than the offender, who was involved in the investigation or prosecution of the offence; or

 except with the court’s approval, an opinion or recommendation about the sentence.

Name of community on whose behalf the statement is made: 

Explain how the statement reflects this community’s views:  

You may present a detailed account of the impact the offence has had on the community. The following sections are examples of information you may wish to include in your statement. You are not required to include all of this information.

Emotional impact

Describe how the offence has affected community members emotionally. For example, think of

 community members’ lifestyles and activities;

 community members’ relationships with others in the community and outside it;

 community members’ ability to work, attend school or study;

 community members’ feelings, emotions and reactions as they relate to the offence; and

 the community’s sense of belonging to the region.

Physical impact

Describe how the offence has affected community members physically. For example, think of

 the ability of community members to access services; and

 changes in transportation and routes taken to and from school, work, shopping, etc.

Economic impact

Describe how the offence has affected the community financially. For example, think of

 any reduction in the number of visitors or tourists to the region;

 the value of any property that was lost or damaged and the cost of repairs or replacement; and

 any costs or losses that are not covered by insurance.

Please note that this is not an application for compensation or restitution.

  Fears for security

Describe any fears that community members have for their security or that of their family and friends. For example, think of concerns with respect to contact with the offender. 

Drawing, poem or letter

You may use this space to draw a picture or write a poem or letter if it will help you express the impact that the offence has had on the community.

 I would like to present this statement in court.

To the best of my knowledge, the information contained in this statement is true.

Dated this  day of  20, at  .

Signature of declarant

Form 35

FORM 35 (Sections 570 and 806)

Conviction

Canada,

Province of ,

(territorial division).

Be it remembered that on the  day of  at , A.B., (date of birth) hereinafter called the accused, was tried under Part (XIX or XXVII) of the Criminal Code on the charge that (state fully the offence of which accused was convicted), was convicted of the said offence and the following punishment was imposed on him, namely,

Use whichever of the following forms of sentence is applicable:

(a) that the said accused be imprisoned in the (prison) at  for the term of ;

(b) that the said accused forfeit and pay the sum of  dollars to be applied according to law and also pay to  the sum of  dollars in respect of costs and in default of payment of the said sums forthwith (or within a time fixed, if any), to be imprisoned in the (prison) at  for the term of unless the said sums and the costs and charges of the committal and of conveying the accused to the said prison are sooner paid;

(c) that the said accused be imprisoned in the (prison) at  for the term of  and in addition forfeit and pay the sum of  dollars to be applied according to law and also pay to  the sum of  dollars in respect of costs and in default of payment of the said sums forthwith (or within a time fixed, if any), to be imprisoned in the (prison) at  for the term of  (if sentence to be consecutive, state accordingly) unless the said sums and the costs and charges of the committal and of conveying the accused to the said prison are sooner paid.

Dated this  day of  A.D. , at  .

Clerk of the Court, Justice or Provincial Court Judge

(Seal, if required)

Form 36

FORM 36 (Sections 570 and 806)

Order Against an Offender

Canada,

Province of ,

(territorial division).

Be it remembered that on the  day of  A.D. , at , A.B., (date of birth) of , was tried on an information (indictment) alleging that (set out matter of complaint or alleged offence), and it was ordered and adjudged that (set out the order made).

Dated this  day of  A.D. , at 

Justice or Clerk of the Court

Form 37

FORM 37 (Section 570)

Order Acquitting Accused

Canada,

Province of ,

(territorial division).

Be it remembered that on the  day of  A.D. , at  A.B., of , (occupation), (date of birth) was tried on the charge that (state fully the offence of which accused was acquitted) and was found not guilty of the said offence.

Dated this  day of  A.D. , at  .

Provincial Court Judge or Clerk of the Court

(Seal, if required)


Form 38

FORM 38 

(Section 708)

Conviction for Contempt

Canada,

Province of  ,

(territorial division).

Be it remembered that on (date) , at  (place) in the (territorial division), E.‍F. of  , in this conviction called the defaulter, is convicted for contempt in that they did not attend before (set out court or justice) to give evidence on the trial of a charge that (state fully offence with which accused was charged), although (duly subpoenaed or bound by recognizance to attend to give evidence, as the case may be) and has not shown any sufficient excuse for their default;

The defaulter is therefore convicted for their default, (set out punishment as authorized and determined in accordance with section 708 of theCriminal Code).

Dated (date) , at  (place).

(Signature of judge, provincial court judge, justice or clerk of the court)

(Seal, if required)

Form 39

FORM 39 

(Sections 519 and 550)

Order for Discharge of a Person in Custody

Canada,

Province of  ,

(territorial division).

To the keeper of the (prison) at  :

You are directed to release E.‍F.‍, detained by you under a (warrant of committal or order) dated (date) , if E.‍F. is detained by you for no other cause.

(Signature of judge, justice or clerk of the court)

(Seal, if required)

Form 40

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)


Form 41

FORM 41 (Section 639)

Challenge for Cause

Canada,

Province of ,

(territorial division).

The Queen

v.

C.D.

The (prosecutor or accused) challenges G.H. on the ground that (set out ground of challenge in accordance with subsection 638(1) of the Criminal Code).

Counsel for (prosecutor or accused)

Form 42

FORM 42 (Section 827)

Certificate of Non-payment of Costs of Appeal

In the Court of 

(Style of Cause)

I hereby certify that A.B. (the appellant or respondent, as the case may be) in this appeal, having been ordered to pay costs in the sum of  dollars, has failed to pay the said costs within the time limited for the payment thereof.

Dated this  day of  A.D. , at  .

Clerk of the Court of 

(Seal)


Form 43

FORM 43 (Section 744)

Jailer’s Receipt to Peace Officer for Prisoner

I hereby certify that I have received from X.Y., a peace officer for (territorial division), one A.B., together with a (warrant or order) issued by (set out court or justice, as the case may be).

Add a statement of the condition of the prisoner

Dated this  day of  A.D. , at  .

Keeper of (prison)

Form 44

FORM 44 (Section 667)

I, (name), a fingerprint examiner designated as such for the purposes of section 667 of the Criminal Code by the Minister of Public Safety and Emergency Preparedness, do hereby certify that (name) also known as (aliases if any), FPS Number , whose fingerprints are shown reproduced below (reproduction of fingerprints) or attached hereto, has been convicted, discharged under section 730 of the Criminal Code or convicted and sentenced in Canada as follows:

(record)

Dated this  day of  A.D. , at 

Fingerprint Examiner

Form 45

FORM 45 (Section 667)

I, (name), a fingerprint examiner designated as such for the purposes of section 667 of the Criminal Code by the Minister of Public Safety and Emergency Preparedness, do hereby certify that I have compared the fingerprints reproduced in or attached to exhibit A with the fingerprints reproduced in or attached to the certificate in Form 44 marked exhibit B and that they are those of the same person.

Dated this  day of  A.D. , at  .

Fingerprint Examiner

Form 46

FORM 46 Section 732.1)

Probation Order

Canada,

Province of ,

(territorial division).

Whereas on the  day of  at , A.B., hereinafter called the offender, (pleaded guilty to or was tried under (here insert Part XIX, XX or XXVII, as the case may be) of the Criminal Code and was (here insert convicted or found guilty, as the case may be) on the charge that (here state the offence to which the offender pleaded guilty or for which the offender was convicted or found guilty, as the case may be);

And whereas on the  day of  the court adjudged

Use whichever of the following forms of disposition is applicable:

(a) that the offender be discharged on the following conditions:

(b) that the passing of sentence on the offender be suspended and that the said offender be released on the following conditions:

(c) that the offender forfeit and pay the sum of  dollars to be applied according to law and in default of payment of the said sum without delay (or within a time fixed, if any), be imprisoned in the (prison) at  for the term of  unless the said sum and charges of the committal and of conveying the said offender to the said prison are sooner paid, and in addition thereto, that the said offender comply with the following conditions:

(d) that the offender be imprisoned in the (prison) at  for the term of  and, in addition thereto, that the said offender comply with the following conditions:

(e) that following the expiration of the offender’s conditional sentence order related to this or another offence, that the said offender comply with the following conditions:

(f) that following the expiration of the offender’s sentence of imprisonment related to another offence, that the said offender comply with the following conditions:

(g) when the offender is ordered to serve the sentence of imprisonment intermittently, that the said offender comply with the following conditions when not in confinement:

Now therefore the said offender shall, for the period of  from the date of this order (or, where paragraph (d), (e) or (f) is applicable, the date of expiration of the offender’s sentence of imprisonment or conditional sentence order) comply with the following conditions, namely, that the said offender shall keep the peace and be of good behaviour, appear before the court when required to do so by the court and notify the court or probation officer in advance of any change of name or address and promptly notify the court or probation officer of any change of employment or occupation, and, in addition,

(here state any additional conditions prescribed pursuant to subsection 732.1(3) of the Criminal Code).

Dated this  day of  A.D. , at  .

Clerk of the Court, Justice or Provincial Court Judge


Form 47

FORM 47 (Section 462.48)

Order To Disclose Income Tax Information

Canada,

Province of ,

(territorial division).

To A.B., of , (office or occupation):

Whereas, it appears on the oath of C.D., of , that there are reasonable grounds for believing that E.F., of , has committed or benefited from the commission of the offence of  and that the information or documents (describe information or documents) are likely to be of substantial value to an investigation of that offence or a related matter; and

Whereas there are reasonable grounds for believing that it is in the public interest to allow access to the information or documents, having regard to the benefit likely to accrue to the investigation if the access is obtained;

This is, therefore, to authorize and require you between the hours of (as the judge may direct), during the period commencing on  and ending on , to produce all the above-mentioned information and documents to one of the following police officers, namely, (here name police officers) and allow the police officer to remove the information or documents, or to allow the police officer access to the above-mentioned information and documents and to examine them, as the judge directs, subject to the following conditions (state conditions): 

Dated this  day of  A.D. , at  .

Signature of judge