CACR

THE COURT OF APPEAL FOR SASKATCHEWAN

BETWEEN:

Appellant

AND:

Respondent

AFFIDAVIT IN SUPPORT

I, (name of applicant), of (city or town), Saskatchewan, hereby make oath and say as follows:

• 1. That I am the Appellant/Applicant on this appeal and make this Affidavit in support of my application for the appointment of legal counsel pursuant to section 684 of the Criminal Code (Canada).

• 2. [In as many paragraphs as you need, describe all of your personal circumstances, including financial situation, education, family situation, work history, etc.]

SWORN at Province of Saskatchewan, this day of 20 .
A COMMISSIONER FOR OATHS in and for Saskatchewan.
My commission expires .