Canada,

Province of ................,

(territorial division).

To the peace officers in the said (territorial division) and to the keeper of the (prison) at ....................:

Whereas E.F. of ................, hereinafter called the defaulter, was on the ................ day of ................ A.D. ........, at ................., convicted before ................ for contempt in that he did not attend before ................ to give evidence on the trial of a charge that (state offence as in the information) against A.B. of ................, although (duly subpoenaed or bound by recognizance to appear and give evidence in that behalf, as the case may be) and did not show any sufficient excuse for his default;

And Whereas in and by the said conviction it was adjudged that the defaulter (set out punishment adjudged);

And Whereas the defaulter has not paid the amounts adjudged to be paid; (delete if not applicable)

This is therefore to command you, in Her Majesty’s name, to arrest, if necessary, and take the defaulter and convey him safely to the prison at ................ and there deliver him to the keeper thereof, together with the following precept:

I do hereby command you, the said keeper, to receive the defaulter into your custody in the said prison and imprison him there* and for so doing this is a sufficient warrant.

*Insert whichever of the following is applicable:

(a) for the term of ................;

(b) for the term of ................ unless the said sums and the costs and charges of the committal and of conveying the defaulter to the said prison are sooner paid;

(c) for the term of ................ and for the term of (if consecutive so state) unless the said sums and the costs and charges of the committal and of conveying the defaulter to the said prison are sooner paid.

Dated this ................ day of ............... A.D. ........, at ................ .

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

A Justice or Clerk of

the Court

(Seal, if required)

Canada,

Province of ................,

(territorial division).

To the peace officers of (territorial division) and to the keeper of the (prison) at ....................:

Whereas it appears that on the hearing of an appeal before the (set out court) it was adjudged that A.B., of ................, hereinafter called the defaulter, should pay to the Clerk of the Court the sum of ................ dollars in respect of costs;

And Whereas the Clerk of the Court has certified that the defaulter has not paid the sum within the time limited therefor;

I do hereby command you, the said peace officers, in Her Majesty’s name, to take the defaulter and safely convey him to the (prison) at ................ and deliver him to the keeper thereof, together with the following precept:

I do hereby command you, the said keeper, to receive the defaulter into your custody in the said prison and imprison him for the term of ................, unless the said sum and the costs and charges of the committal and of conveying the defaulter to the said prison are sooner paid, and for so doing this is a sufficient warrant.

Dated this ................ day of ................ A.D. ........, at ................ .

Canada,

Province of ................,

(territorial division).

To the sheriff of (territorial division) and to the keeper of the (prison) at ................:

You are hereby commanded to arrest, if necessary, and take (A.B. and C.D. as the case may be) hereinafter called the defaulters, and to convey them safely to the (prison) at ................ and deliver them to the keeper thereof, together with the following precept:

You, the said keeper, are hereby commanded to receive the defaulters into your custody in the said prison and imprison them for a period of ................ or until satisfaction is made of a judgment debt of ............ dollars due to Her Majesty the Queen in respect of the forfeiture of a recognizance entered into by ................ on the ................ day of ................ A.D. ........ .

Dated this ................ day of ................ A.D. ........ .

(Seal)

Canada,

Province of ............,

(territorial division).

Pursuant to application this day made to me, I hereby authorize the arrest of the accused (or defendant) (or execution of this warrant in the case of a warrant issued pursuant to section 487), within the said (territorial division).

Dated this ........ day of ............ A.D. ........, at .............

Canada,

Province of ............,

(territorial division).

Pursuant to application this day made to me, I hereby authorize the execution of this order, in the case of an order issued under section 487.051 or 487.052 (or execution of this authorization in the case of an authorization issued under section 487.055 or 487.091), within the said (territorial division).

Dated this ........ day of ......... A.D. ........, at ............

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

Judge of the Provincial Court

Canada,

Province of ................,

(territorial division).

Whereas this warrant is issued under section 507, 508 or 512 of the Criminal Code in respect of an offence other than an offence mentioned in section 522 of the Criminal Code, I hereby authorize the release of the accused pursuant to section 499 of that Act.

Dated this ................ day of ................ A.D. ........, at ................ .

Canada,

Province of ................,

(territorial division).

To the keeper of the (prison) at ................:

Whereas by warrant dated the ................ day of ................ A.D. ........, I committed A.B., hereinafter called the accused, to your custody and required you safely to keep until the ................ day of ................ A.D. ........, and then to have him before me or any other justice at ................ at ............ o’clock in the ........ noon to answer to the charge against him and to be dealt with according to law unless you should be ordered otherwise before that time;

Now, therefore, I order and direct you to have the accused before ................ at ................ at ............ o’clock in the ........ noon to answer to the charge against him and to be dealt with according to law.

Dated this ................ day of ................ A.D. ........, at ................ .

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.

Canada,

Province of ................,

(territorial division).

Be it remembered that on this day the persons named in the following schedule personally came before me and severally acknowledged themselves to owe to Her Majesty the Queen the several amounts set opposite their respective names, namely,

to be made and levied of their several goods and chattels, lands and tenements, respectively, to the use of Her Majesty the Queen, if the said A.B. fails in any of the conditions hereunder written.

Taken and acknowledged before me on the ................ day of ................ A.D. ........, at ................ .

1. Whereas the said ................, hereinafter called the accused, has been charged that (set out the offence in respect of which the accused has been charged);

Now, therefore, the condition of this recognizance is that if the accused attends court on .............. day, the .................. day of ........................ A.D. ...................., at ......................... o’clock in the ................... noon and attends thereafter as required by the court in order to be dealt with according to law (or, where date and place of appearance before court are not known at the time recognizance is entered into if the accused attends at the time and place fixed by the court and attends thereafter as required by the court in order to be dealt with according to law) [515, 520, 521, 522, 523, 524, 525, 680];

And further, if the accused (insert in Schedule of Conditions any additional conditions that are directed),

the said recognizance is void, otherwise it stands in full force and effect.

2. Whereas the said ................, hereinafter called the appellant, is an appellant against his conviction (or against his sentence) in respect of the following charge (set out the offence for which the appellant was convicted) [679, 680];

Now, therefore, the condition of this recognizance is that if the appellant attends as required by the court in order to be dealt with according to law;

And further, if the appellant (insert in Schedule of Conditions any additional conditions that are directed),

the said recognizance is void, otherwise it stands in full force and effect.

3. Whereas the said ................, hereinafter called the appellant, is an appellant against his conviction (or against his sentence or against an order or by way of stated case) in respect of the following matter (set out offence, subject-matter of order or question of law) [816, 831, 832, 834];

Now, therefore, the condition of this recognizance is that if the appellant appears personally at the sittings of the appeal court at which the appeal is to be heard;

And further, if the appellant (insert in Schedule of Conditions any additional conditions that are directed),

the said recognizance is void, otherwise it stands in full force and effect.

4. Whereas the said ................, hereinafter called the appellant, is an appellant against an order of dismissal (or against sentence) in respect of the following charge (set out the name of the defendant and the offence, subject-matter of order or question of law) [817, 831, 832, 834];

Now, therefore, the condition of this recognizance is that if the appellant appears personally or by counsel at the sittings of the appeal court at which the appeal is to be heard the said recognizance is void, otherwise it stands in full force and effect.

5. Whereas the said ................, hereinafter called the accused, was ordered to stand trial on a charge that (set out the offence in respect of which the accused has been charged);

And whereas A.B. appeared as a witness on the preliminary inquiry into the said charge [550, 706, 707];

Now, therefore, the condition of this recognizance is that if the said A.B. appears at the time and place fixed for the trial of the accused to give evidence on the indictment that is found against the accused, the said recognizance is void, otherwise it stands in full force and effect.

6. The condition of the above written recognizance is that if A.B. keeps the peace and is of good behaviour for the term of ...... commencing on ......, the said recognizance is void, otherwise it stands in full force and effect [810 and 810.1].

7. Whereas a warrant was issued under section 462.32 or a restraint order was made under subsection 462.33(3) of the Criminal Code in relation to any property (set out a description of the property and its location);

Now, therefore, the condition of this recognizance is that A.B. shall not do or cause 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 the Criminal Code or any other provision of the Criminal Code or any other Act of Parliament [462.34].

Schedule of Conditions

(a) reports at (state times) to (name of peace officer or other person designated);

(b) remains within (designated territorial jurisdiction);

(c) notifies (name of peace officer or other person designated) of any change in his address, employment or occupation;

(d) abstains from communicating, directly or indirectly, with (identification of victim, witness or other person) except in accordance with the following conditions: (as the justice or judge specifies);

(e) deposits his passport (as the justice or judge directs); and

(f) (any other reasonable conditions).

Note: Section 763 and subsections 764(1) to (3) of the Criminal Code state as follows:

“763. Where a person is bound by recognizance to appear before a court, justice or provincial court judge for any purpose and the session or sittings of that court or the proceedings are adjourned or an order is made changing the place of trial, that person and his sureties continue to be bound by the recognizance in like manner as if it had been entered into with relation to the resumed proceedings or the trial at the time and place at which the proceedings are ordered to be resumed or the trial is ordered to be held.

764. (1) Where an accused is bound by recognizance to appear for trial, his arraignment or conviction does not discharge the recognizance, but it continues to bind him and his sureties, if any, for his appearance until he is discharged or sentenced, as the case may be.

(2) Notwithstanding subsection (1), the court, justice or provincial court judge may commit an accused to prison or may require him to furnish new or additional sureties for his appearance until he is discharged or sentenced, as the case may be.

(3) The sureties of an accused who is bound by recognizance to appear for trial are discharged if he is committed to prison pursuant to subsection (2).”

I hereby certify that A.B. (has not appeared as required by this recognizance or has not complied with a condition of this recognizance) and that by reason thereof 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 this ................ day of ................ A.D. ........, at ................ .

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:

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

(Seal)

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)

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

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

(Seal, if required)

Canada,

Province of ................,

(territorial division).

Be it remembered that on the ................ day of ................ A.D. ........, at ................ in the (territorial division), E.F. of ................, hereinafter called the defaulter, is convicted by me for contempt in that he 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 before me any sufficient excuse for his default;

Wherefore I adjudge the defaulter for his said default, (set out punishment as authorized and determined in accordance with section 708 of the Criminal Code).

Dated this ................ day of ................ A.D. ........, at ................ .

(Seal, if required)

Canada,

Province of ................,

(territorial division).

To the keeper of the (prison) at ................:

I hereby direct you to release E.F., detained by you under a (warrant of committal or order) dated the ................ day of ................ A.D. ........, if the said E.F. is detained by you for no other cause.

(Seal, if required)

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

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).

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

(Seal)

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

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

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

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