Court File No.___________

PROVINCIAL COURT
(SPECIFY COURT LOCATION) 
(Criminal Division)

BETWEEN.

HER MAJESTY THE QUEEN

-and-

(SPECIFY NAME OF ACCUSED)


AFFIDAVIT OF SERVICE



		I, (full name of affiant, of the (City, Town, etc.) of _______________, in the Province of _______________ (set out the affiants capacity), MAKE OATH AND SAY (or AFFIRM):



(personal service)

1	On (date) at (time), I served (Identify person served) with the (identify document(s) served) by leaving a copy with him (or her) at (address where service was made). (Where the Practice Directives provide for personal service on a corporation, etc., by leaving a copy of the document with another person, substitute: by leaving a copy with (identify person by name and title) at (address where service was made).)

2.	I was able to identify the person by means of (state the means by which the person’s identity was ascertained.)


SWORN (or affirmed) before me at the (City, Town, etc.) of _________________ in the (County, District, Regional Municipality, Province etc.) of _______________ on ___________________ (date).



Commissioner for Taking Oaths (or as may be)
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