Court File No.

APPLICATION FOR REVIEW OF PAROLE INELIGIBILITY

(Criminal Code, s. 745(1))

(Review of Parole Ineligibility Rules, Rule 50.03, Form 20)

ONTARIO COURT OF JUSTICE

(GENERAL DIVISION)

((specify)Region)

B E T W E E N:

HER MAJESTY THE QUEEN

- and -

(specify given names and surname of applicant)

Application for a reduction in the number of years of imprisonment without eligibility for parole pursuant to section 745 of the Criminal Code

TO the Honourable Chief Justice of the Ontario Court.

• 1 I, (given names and surname of the applicant), born on (applicant’s date of birth) and currently detained at (name and place of the institution), hereby request, pursuant to section 745 of the Criminal Code, that the number of years of imprisonment during which I will not be eligible for parole with respect to the sentence imposed on me on (give date of sentencing) at (give place of trial) be reduced to

• 2 Since my arrest for the offence referred to in paragraph 3, I have been detained in the following institutions: (Give a COMPLETE list of the names and places of the institutions in which the applicant has been detained and specify the date of entry into each of the institutions).

• 3 The sentence referred to in paragraph l was imposed on me for the following offence: (Indicate the offence for which the applicant was convicted and give the date of conviction).

• 4 The sentence imposed on me was (give a description of the sentence) and the number of years of imprisonment without eligibility for parole was set at (give number of years). (Indicate whether the sentence has been commuted and, if so, give the date of commutation.)

• 5 My criminal record is as follows: (Give a complete list of convictions and sentences and indicate the date of each).

• 6 In support of my application I am relying on the following grounds: (Specify ALL grounds PRECISELY and CONCISELY).

• 7 My address for service is: (Give complete address).

Filed with the Registrar of the Ontario Court (General Division) in Toronto on

(Signature of Applicant)

Court File No.

AFFIDAVIT IN SUPPORT OF APPLICATION FOR REVIEW OF PAROLE INELIGIBILITY

(Criminal Code, s. 745(1))

(Review of Parole Ineligibility Rules, Rule 50.05, Form 21)

ONTARIO COURT OF JUSTICE

(GENERAL DIVISION)

((specify)Region)

B E T W E E N:

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

I, the undersigned, (given names and surname of the applicant), currently detained at (name and place of institution), in the Province of , make oath and say (or affirm) as follows:

• 1 I am 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