Criminal Code

Canada,

Province of ,

(territorial division).

To the keeper of the (prison) at :

Whereas by warrant dated the day of A.D. , I committed A.B., hereinafter called the accused, to your custody and required you safely to keep until the day of A.D. , and then to have him before me or any other justice at at o’clock in the noon to answer to the charge against him and to be dealt with according to law unless you should be ordered otherwise before that time;

Now, therefore, I order and direct you to have the accused before at at o’clock in the noon to answer to the charge against him and to be dealt with according to law.

Dated this day of A.D. , at .

A Justice of the Peace in and for