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 FOR CHANGE IN OPTIONAL
CONDITIONS OF PROBATION ORDER


       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 to change the Probation Order made the ________ day of _________________________ (specify month) 20______.


* The optional conditions sought to be changed are: (check if applicable)
Clause _________

* The optional conditions from which the applicant seeks temporary or permanent relief are:
Clause _________

* A decrease in the length of the term of the Probation Order is sought.

The above noted changes are sought for the following reasons:




IN SUPPORT OF THIS APPLICATION THE APPLICANT RELIES UPON THE FOLLOWING:

1.	Copy of the existing Probation Order sought to be changed.

2.	(set out documents such as affidavits or other documents upon which the applicant relies).


DATED at ________________________ this __________ day of _________________ 20____.


__________________________________________
(Signature of applicant or counsel - set out name, address as well as telephone and fax number)