Court File No.___________

PROVINCIAL COURT
(SPECIFY COURT LOCATION)
(Criminal Division)

BETWEEN:

HER MAJESTY THE QUEEN
(indicate whether applicant or respondent)

-and-

(SPECIFY NAME OF ACCUSED)
(indicate whether applicant or respondent)

NOTICE OF APPLICATION

	TAKE NOTICE that an application will be brought on ____ day, the _____ day of (specify month). 20___ at (time of day) or as soon thereafter as the application can be heard at (specify address of court house and courtroom number if known) for an order granting:

       THE RELIEF SOUGHT IS:
	1.	An Order allowing the application and granting (indicate particular relief sought)

	THE GROUNDS FOR THIS APPLICATION ARE:
	1.	That...
	2.	That...
	3.	Such further and other grounds as counsel may advise and this Honourable Court may permit

	IN SUPPORT OF THIS APPLICATION, THE APPLICANT RELIES UPON THE FOLLOWING:
	1.	(set out documents such as transcripts. etc. upon which the Applicant relies)

	
	THE APPLICANT MAY BE SERVED WITH DOCUMENTS PERTINENT TO THIS APPLICATION
	1.	By service in accordance with Practice Directive 5, through (specify address and fax number)

	DATED at _____________________ this _________ day of _________ 20____.



____________________________________
(signature of applicant or counsel) (set out name and address, as well as telephone and fax numbers)


_____________________________
Issued by Staff Justice of the Peace