Rules of the Supreme Court of Canada

TAKE NOTICE that, pursuant to leave granted by the Supreme Court of Canada on (date), (name of appellant) appeals to the Court from the judgment of the (name of the court appealed from) made on (date);

OR

TAKE NOTICE that (name of appellant) appeals as of right to the Supreme Court of Canada under (cite the legislative provision or provisions that authorize the appeal) from the judgment of the (name of the court appealed from and file number from that court) made on (date);

(In the case of an appeal under paragraph 691(1)(a) or (2)(a) or (b), 692(3)(a) or 693(1)(a) of the Criminal Code, state the following:)

AND FURTHER TAKE NOTICE that this appeal raises the following question or questions of law:

AND/OR

AND FURTHER TAKE NOTICE that the dissenting judgment of the court appealed from is, in whole or in part, based on the following questions of law (as specified in the judgment issued under section 677 of the Criminal Code):

Dated at (place), (province or territory) this (date) day of (month), (year).

SIGNED BY (signature of counsel or party or agent)

Appellant (Counsel’s (or party’s, if unrepresented) name, address and telephone number, and fax number and email address (if any))

Agent (Agent’s name, address and telephone number, and fax number and email address (if any))

ORIGINAL TO: THE REGISTRAR

COPIES TO: (Name, address and telephone number, and fax number and email address (if any), of every party and all other parties and interveners in the court appealed from)

(In the case of an appeal as of right, include a copy of the judgment and reasons for judgment of the court appealed from and a copy of the certificate in Form 23A and, if applicable, a copy of the certificates in Form 23B or 23C.)