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FORM 21

Court File No.  

AFFIDAVIT IN SUPPORT OF APPLICATION FOR REVIEW
OF PAROLE INELIGIBILITY
(Criminal Code, s745(1))
(Review of Parole Ineligibility Rules, Rule 50.05, Form 21)

ONTARIO COURT OF JUSTICE
(GENERAL DIVISION)
((specify) Region)

BETWEEN:  

HER MAJESTY THE QUEEN

-and-

(specify given names and surname of applicant)

Application of (given names and surname of the applicant) made pursuant to section 745 of the Criminal Code
 
    1. Iam the applicant.
    2. The facts set out in the attached application are true.
_____________________
(Signature of applicant)
 
___________________________
Sworn (or Affirmed) before me on ____________,199______,at________________
 
_______________________
  Commissioner for Oaths
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